Anti-cholinergic drug burden in patients with dementia increases after hospital admission: a multicentre cross-sectional study

BMC Geriatr. 2022 Oct 6;22(1):783. doi: 10.1186/s12877-022-03235-9.


Background: Anticholinergic medications are drugs that block cholinergic transmission, either as their primary therapeutic action or as a secondary effect. Patients with dementia may be particularly sensitive to the central effects of anticholinergic drugs. Anticholinergics also antagonise the effects of the main dementia treatment, cholinesterase inhibitors. Our study aimed to investigate anticholinergic prescribing for dementia patients in UK acute hospitals before and after admission.

Methods: We included 352 patients with dementia from 17 UK hospital sites in 2019. They were all inpatients on surgical, medical or Care of the Elderly wards. Information about each patient's medications were collected using a standardised form, and the anticholinergic drug burden of each patient was calculated with an evidence-based online calculator. Wilcoxon's rank test was used to look at the correlation between two subgroups upon admission and discharge.

Results: On admission to hospital, 37.8% of patients had an anticholinergic burden score ≥ 1 and 5.68% ≥3. On discharge, 43.2% of patients with an anticholinergic burden score ≥ 1 and 9.1% ≥3. The increase in scores was statistically significant (p = 0.001). Psychotropics were the most common group of anticholinergic medications prescribed at discharge. Of those patients taking cholinesterase inhibitors, 44.9% were also prescribed anticholinergic medications.

Conclusions: Our cross-sectional, multicentre study found that people with dementia are commonly prescribed anticholinergic medications, even if concurrently taking cholinesterase inhibitors, and are significantly more likely to be discharged from hospital with a higher anticholinergic burden than on admission.

Keywords: Alzheimer disease; Antidepressive agents; Antipsychotic agents; Cholinesterase inhibitors; Cognition; Cognitive dysfunction; Dementia; Memory disorders; Muscarinic antagonists; Polypharmacy.

Publication types

  • Multicenter Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Aged
  • Cholinergic Antagonists / adverse effects
  • Cholinesterase Inhibitors* / therapeutic use
  • Cross-Sectional Studies
  • Dementia* / chemically induced
  • Dementia* / drug therapy
  • Dementia* / epidemiology
  • Hospitals
  • Humans


  • Cholinergic Antagonists
  • Cholinesterase Inhibitors