• Medications with anticholinergic effects are known to increase the risk of cognitive impairment, dementia and early death in older adults.
  • Anticholinergic drugs have a cumulative effect on cognition.
  • The Anticholinergic Effect on Cognition (AEC) scale aims to help clinicians to identify which drugs have an anticholinergic effect on cognition and defines the extent of this effect.
  • The AEC scale takes into account the anticholininergic effect of a drug, the extent of this effect, whether it is able to penetrate the brain or not and whether there are in fact reports of cognitive impairment with the drug to support the score given.

Note: This scale scores drugs according to anticholinergic safety only

Medications are categorised according to their anticholinergic score as follows:


Review and withdraw or switch


Review and withdraw or switch


Caution required


Safe to use


Limited data - unable to scope
  • Consider reviewing all individual drugs with an AEC score of 2 or above to see whether they can either be withdrawn or switched to a drug with a lower AEC score (preferably 0).
  • The individual AEC scores of drugs are added together for each patient so as to calculate the total AEC score.
  • Consider carrying out a medication review for all patients with a total AEC score of 3 or above to see whether the total AEC score can be reduced to the minimum possible.

Note that drug dosage is not taken into account when using this scale.

Do not make any changes to your medication without discussion with your treating physician.

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