Why ACB?
ACB is a practical screening scale for cognitive anticholinergic burden, not a diagnosis.
What the medication list is quietly costing.
Anticholinergic burden accumulates across ordinary prescriptions and shows up as fog, unsteadiness, and falls. This scores it and gives you something to ask about.
Anticholinergic Burden Calculator
Estimate cognitive anticholinergic burden with the ACB scale.
No single anticholinergic burden scale is the universal standard. This tool keeps ACB because it is widely used, cognition-focused, and easy to discuss during a medication review.
What this list is
A common-medication subset. If a medication is not listed, bring the full list to a pharmacist.
What it misses
ACB does not adjust for dose, drug interactions, kidney or liver clearance, or total frailty.
Citation: ACB scoring assigns 1 point for possible anticholinergic activity and 2 or 3 points for definite anticholinergic activity; total scores of 3 or higher are commonly used as a medication review threshold. This is a common-medication subset, not a complete drug database. ACB scores vary from other scales, no gold-standard scale exists, and this educational screen is not medical advice; consult a qualified clinician or pharmacist before changing medications.
Burden is cumulative, which is why it gets missed.
No single prescription on a typical list looks alarming. The problem is additive: a sleep aid, a bladder medication, and an antihistamine can each be individually reasonable and together produce a burden score associated with measurable cognitive and physical effects.
Because each drug was usually started by a different prescriber for a different reason, nobody is looking at the total. That is the gap this tool is meant to close, and the output is written as questions rather than conclusions for exactly that reason.
Where this leads