Polypharmacy and the Ageing Brain: Anticholinergic Burden in the Ageing Population and the Impact of Gynaecological Medications

Background: Population ageing is accelerating worldwide, accompanied by a rising prevalence of multimorbidity and polypharmacy. Medicines with anticholinergic properties are commonly prescribed to older adults for a wide range of conditions, including depression, urinary incontinence, Parkinson’s disease, allergies, and respiratory disorders. While short-term anticholinergic effects such as dry mouth and constipation are well recognised, increasing evidence suggests that cumulative anticholinergic exposure may contribute to adverse cognitive outcomes in older populations.Objective: This review aims to discuss the concept of anticholinergic burden, outline commonly used tools to quantify exposure, and examine the evidence linking cumulative anticholinergic exposure with cognitive decline and other adverse health outcomes. It also explores strategies to identify and mitigate anticholinergic burden in clinical practice.Methods: Relevant literature on anticholinergic medications, burden scales, and associated clinical outcomes was reviewed. Attention was given to validated measurement tools such as the Anticholinergic Cognitive Burden (ACB) scale, Anticholinergic Risk Scale (ARS), and Anticholinergic Drug Scale (ADS), as well as studies examining associations between anticholinergic exposure and cognitive and functional outcomes.Results: Evidence from observational studies indicates that higher cumulative anticholinergic burden is associated with increased risks of cognitive impairment, delirium, falls, functional decline, and possibly dementia. Measurement tools allow clinicians and researchers to estimate cumulative exposure, with several studies identifying clinically meaningful risk at moderate to high burden scores. Conclusion: Anticholinergic burden represents a potentially modifiable contributor to adverse outcomes in ageing populations. Routine assessment of anticholinergic exposure, careful medication review, and deprescribing strategies where appropriate may help reduce avoidable cognitive and functional harm in older adults. Integrating burden assessment into prescribing systems and clinical decision support tools may further support safer pharmacotherapy in an ageing society.