Building an anticholinergic medication evidence inventory

Introduction

Published anticholinergic scales differ in drug inclusion, source selection, and category assignment. A searchable directory can make those differences visible, but a value from one scale must retain its original meaning and provenance. This report describes the bounded UnifiedACB v1.0 evidence inventory; it does not test whether one scale predicts patient outcomes better than another. A recent systematic review found substantial variation among burden scales without a gold standard. ^{1, 2, 3, 6}

For a medication review, disagreement is an observable feature of the literature rather than a reason to silently choose one rating. It is also important to distinguish the count of drug identities from the count of scale observations. A single source may rate many ingredients, and an ingredient may have multiple rows from separate publications or value sources. The inventory was organized to preserve those distinctions and expose where a primary-source check remains open. ⁴

Methods

A stable ingredient identifier was reconciled with generic names, routes, and source records. Scale observations were retained under their named families: Anticholinergic Cognitive Burden (ACB), Anticholinergic Risk Scale (ARS), Anticholinergic Drug Scale (ADS), Korean Anticholinergic Burden Scale (KABS), and CRIDECO Anticholinergic Load Scale (CALS). A published zero was treated as a reported category; an absent value remained missing. The first 200 priority records underwent a deeper comparison, including direct CALS publication matches and a KABS–CALS disagreement check. ⁴

Counts describe the frozen workbook and companion audit dated September 28, 2026. An evidence row is a scale observation, not an independent publication or a verified clinical effect. Original supplement row checks and reuse review remain open for some imported sources. ⁴

The comparison retained the publication's own category and linked provenance rather than averaging unlike 0–3 values. Ingredient-level matching was separated from product-level verification: a shared generic name does not establish that a particular dose, formulation, route, or active metabolite was evaluated in a scale or model. A disagreement flag identifies different KABS and CALS categories for a matched ingredient; it does not adjudicate which category is clinically correct. ^{2, 3, 4}

Audit depth was prioritized rather than assumed uniform across the directory. The first 200 records received a more detailed source comparison, while later directory records may have a direct name match at a shallower review depth or still need identity and source work. This design makes a useful searchable inventory possible while allowing the public display to identify unresolved verification. ⁴

Results

All 200 priority records had at least one named scale rating. In that cohort, 127 CALS matches were supported by the original publication or footnotes, while 196 KABS entries had been imported and still required independent primary-row verification. Thirty-nine records had different KABS and CALS categories. These are source-comparison counts, not estimates of clinical harm. ⁴

The directory contains 557 unique drug records and 1,977 scale observations. Of the 357 records outside the first priority cohort, 333 had at least one literal-name scale-evidence match and 24 still required identity or evidence review in the release notes. A literal-name match should not be interpreted as a fully verified row or a route-specific clinical finding. ⁴

The source-catalog reconciliation added five definition entries and linked missing definition references in the research workbook. This improved traceability of the recorded observations but did not turn copied source rows into independent primary-source verification. The website continues to distinguish source visibility from audit completion. ⁴

Discussion

A source-specific display is useful when it exposes disagreements, missingness, and the exact status of a match. It cannot settle which category is most clinically appropriate for an individual. Ingredient matching alone may not resolve route, dose, formulation, active metabolites, or the publication's population. The directory should be used to frame a review with a clinician and to prioritize source corrections. ⁴

The ledger includes repeated observations and several immediate value-source documents that reproduce older scales. A count of 1,977 rows must not be described as 1,977 independent references. Future work includes primary-source verification, identity review, and versioned corrections. ⁴

This descriptive inventory has no patient-level denominator or outcome analysis. It cannot estimate the frequency of adverse effects, compare the predictive validity of the five scale families, or demonstrate that one category should replace another. The deeper first-200 audit was selected for research priority, so its verification rates and disagreement count should not be extrapolated without qualification to all 557 records. ⁴

A correction workflow should preserve the old value, proposed change, source, adjudication, and date. When a value changes, the reason and affected record should be visible in a public change log without exposing submitter details. Updating the directory must not rewrite the historical frozen score versions used in outcome analyses. Independent row checking and reuse-rights review remain necessary. ⁴

References (AMA style)

1. Rudolph JL, Salow MJ, Angelini MC, McGlinchey RE. The anticholinergic risk scale and anticholinergic adverse effects in older persons. Arch Intern Med. 2008;168(5):508-513. doi:10.1001/archinternmed.2007.106 Source ↗
2. Jun K, Hwang S, Ah YM, Suh Y, Lee JY. Development of an anticholinergic burden scale specific for Korean older adults. Geriatr Gerontol Int. 2019;19(7):628-634. doi:10.1111/ggi.13680 Source ↗
3. Ramos H, Moreno L, Pérez-Tur J, et al. CRIDECO Anticholinergic Load Scale: an updated anticholinergic burden scale. J Pers Med. 2022;12(2):207. doi:10.3390/jpm12020207 Source ↗
4. Chaar M. Research v1.0 release notes: original frozen audit record. Unified ACB Tool; 2026. Published September 28, 2026. Source ↗
5. Carnahan RM, Lund BC, Perry PJ, Pollock BG, Culp KR. The Anticholinergic Drug Scale as a measure of drug-related anticholinergic burden: associations with serum anticholinergic activity. J Clin Pharmacol. 2006;46(12):1481-1486. doi:10.1177/0091270006292126 Source ↗
6. Vennard O, Stewart C, Tolia M, Soiza RL, Myint PK. Anticholinergic medication burden scales: a systematic review. J Am Geriatr Soc. 2026;74(6):1771-1784. doi:10.1111/jgs.70352 Source ↗