Anticholinergic Burden
The parasympathetic nervous system, also called the "rest and digest" system, relies on the neurotransmitter acetylcholine. The effects are Salivation, Lacrimation, Urination, Defecation ("SLUD"), as well as being involved in cognition. Anticholinergic drugs do the opposite of SLUD by causing dry eyes, urinary retention, constipation, and confusion.
Combining multiple drugs with their own individual anticholinergic properties can cause problems due to their additive effects. This is especially a problem in the elderly.
The Anticholinergic Burden (ACB) score helps to gauge risk. Each medication is given a score of 1-3, and the scores are added up. www.acbcalc.com is a useful website for calculation of the ACB score. Younger patients tolerate higher ACB scores.
