bodyType

customContents

entityId

printArticlePageQuery

filter

article

body

urlAlias

articleSectionsContent

articleSeoArticle

articleSourceHeaderArticle

contentSchemaRenderContent

contentSubHeadlineContent

contentHeadlineContent

mainImagePrintArticleArticle

authorBlockPrintArticleArticle

contentSponsorTagContent

articlePianoPaywallContent

scmpYoutubeContent

hooksTrackPageViewArticle

query printArticlePageQuery(
  $entityId: String!
  $customContents: [CustomContentInput]
  $bodyType: BodyFormatTypeEnum
) {
  article(filter: {entityId: $entityId}) {
    entityId
    body(customContents: $customContents, type: $bodyType) {
      json
    }
    urlAlias
    ...articleSectionsContent
    ...articleSeoArticle_3o8td4
    ...articleSourceHeaderArticle
    ...contentSchemaRenderContent
    ...contentSubHeadlineContent
    ...contentHeadlineContent
    ...mainImagePrintArticleArticle
    ...authorBlockPrintArticleArticle
    ...contentSponsorTagContent
    ...articlePianoPaywallContent
    ...scmpYoutubeContent
    ...hooksTrackPageViewArticle
    id
  }
}

fragment articlePianoPaywallContent on Content {
  __isContent: __typename
  ...hooksPaywallPromiseContent
}

fragment articleSectionsContent on Content {
  __isContent: __typename
  sectionsV2 {
    value {
      __typename
      ... on Section {
        name
        published
      }
      ... on VideoSection {
        name
        published
      }
      ...helpersCheckIfNewsSectionInFirstIndexSection
      ...entityLink
      ... on Node {
        __isNode: __typename
        id
      }
    }
  }
}

fragment articleSeoArticle_3o8td4 on Article {
  ...hooksArticleSeoArticle
  ...helpersGetArticleTypeArticle
  entityId
  publishedDate
  updatedDate
  summary {
    text
  }
  subHeadline {
    text
  }
  body(customContents: $customContents, type: $bodyType) {
    text
  }
  keywords
  sectionsV2 {
    value {
      __typename
      ... on Section {
        name
      }
      ... on Node {
        __isNode: __typename
        id
      }
    }
  }
  topics {
    name
    entityId
    id
  }
  urlAlias
  authors {
    name
    id
  }
  images {
    style(filter: {style: "768x768"}) {
      url
    }
  }
  readingTime
}

fragment articleSourceHeaderArticle on Article {
  urlAlias
  ...entityLink
}

fragment authorBlockPrintArticleArticle on Article {
  ...defaultArticleDateContent
  ...authorNamesArticle
}

fragment authorNameAuthor on Author {
  ...entityLink
  name
  entityUuid
}

fragment authorNamesArticle on Article {
  authorLocations
  authors {
    entityId
    location
    ...authorNameAuthor
    id
  }
}

fragment blockquoteQuoteContent on Content {
  __isContent: __typename
  ...contentShareWidgetContent
}

fragment checkersCheckContentContainsStarlingImageContent on Content {
  __isContent: __typename
  topics {
    entityId
    id
  }
}

fragment contentHeadlineContent on Content {
  __isContent: __typename
  headline
  socialHeadline
  ...contentHeadlineTagContent
  ...helpersUseContentSponsorContent
}

fragment contentHeadlineTagContent on Content {
  __isContent: __typename
  ...hooksContentHeadlineTagContent
}

fragment contentNewsletterWidgetContent on Content {
  __isContent: __typename
  topics {
    relatedNewsletters {
      ...helpersMassageToNewsletterItemNewsletter
      id
    }
    id
  }
  sectionsV2 {
    value {
      __typename
      ... on Section {
        relatedNewsletters {
          ...helpersMassageToNewsletterItemNewsletter
          id
        }
      }
      ... on Node {
        __isNode: __typename
        id
      }
    }
  }
  ... on Article {
    relatedNewsletters {
      ...helpersMassageToNewsletterItemNewsletter
      id
    }
  }
}

fragment contentSchemaRenderContent on Content {
  __isContent: __typename
  ...blockquoteQuoteContent
  ...hooksInlinePlusWidgetContent
  ...imageContent
  ...inlineWidgetContent
  ...photoGalleryWidgetContent
  ...scmpYoutubeContent
}

fragment contentShareWidgetContent on Content {
  __isContent: __typename
  __typename
  entityId
  urlAlias
  shortUrl
  socialHeadline
  headline
  ... on Video {
    youtubeId
  }
}

fragment contentSponsorTagContent on Content {
  __isContent: __typename
  ...helpersUseContentSponsorContent
}

fragment contentSubHeadlineContent on Content {
  __isContent: __typename
  subHeadline {
    json
  }
  summary {
    json
  }
  ...contentSchemaRenderContent
}

fragment defaultArticleDateContent on Content {
  __isContent: __typename
  ...hooksArticleDateUtilsContent
}

fragment entityLink on BaseWithApplicationAndUrlAlias {
  __isBaseWithApplicationAndUrlAlias: __typename
  __typename
  entityId
  entityUuid
  urlAlias
  urlRedirect {
    toUrl
    id
  }
  application {
    entityId
    id
  }
  ... on Section {
    fullSectionPath {
      entityId
      id
    }
    parentSection
  }
  ...helpersAppBarVariantBase
  ...helpersApplicationBase
  ...helpersCheckIsPlusArticle
  ...helpersStyleSectionContent
}

fragment helpersAppBarVariantBase on BaseWithApplicationAndUrlAlias {
  __isBaseWithApplicationAndUrlAlias: __typename
  ...helpersCheckIsLiveArticle
  ...helpersCheckIsPlusPage
  ...helpersCheckIsPostMagazineArticle
  ...helpersCheckIsStyleArticle
  ...helpersSectionContent
  ...helpersStyleSectionContent
}

fragment helpersApplicationBase on BaseWithApplicationAndUrlAlias {
  __isBaseWithApplicationAndUrlAlias: __typename
  ...helpersCheckIsPlusPage
}

fragment helpersCheckIfNewsSectionInFirstIndexSection on SectionUnion {
  __isSectionUnion: __typename
  ... on Section {
    name
  }
  ... on VideoSection {
    name
  }
}

fragment helpersCheckIsAmpEnabledArticle on Article {
  entityId
  types {
    value {
      entityId
      id
    }
  }
  sectionsV2 {
    value {
      __typename
      ... on Section {
        entityId
      }
      ... on Node {
        __isNode: __typename
        id
      }
    }
  }
  disableOffPlatformContent
  sponsorType
  published
  ...helpersCheckIsPlusArticle
}

fragment helpersCheckIsLiveArticle on Article {
  flattenTypeIds
  liveArticle {
    status
    id
  }
}

fragment helpersCheckIsMainTopicContent on Content {
  __isContent: __typename
  topics {
    entityId
    id
  }
}

fragment helpersCheckIsPlusArticle on Content {
  __isContent: __typename
  ... on Article {
    paywallTypes {
      entityUuid
      id
    }
  }
}

fragment helpersCheckIsPlusPage on Page {
  urlAlias
}

fragment helpersCheckIsPostMagazineArticle on Content {
  __isContent: __typename
  sectionsV2 {
    value {
      __typename
      ... on Section {
        entityId
      }
      ... on Node {
        __isNode: __typename
        id
      }
    }
  }
}

fragment helpersCheckIsStyleArticle on Content {
  __isContent: __typename
  sectionsV2 {
    value {
      __typename
      ... on Section {
        entityId
      }
      ... on VideoSection {
        entityId
      }
      ... on Node {
        __isNode: __typename
        id
      }
    }
  }
}

fragment helpersGetArticleTypeArticle on Content {
  __isContent: __typename
  ... on Article {
    types {
      value {
        entityId
        id
      }
    }
  }
}

fragment helpersMassageToNewsletterItemNewsletter on Newsletter {
  entityId
  name
  alternativeName
  description {
    text
  }
  summary {
    text
  }
  homepageDescription {
    text
  }
}

fragment helpersSanitizeArticleTypeEntityIdsArticle on Article {
  types {
    value {
      entityId
      id
    }
  }
}

fragment helpersSanitizeAuthorTypesArticle on Article {
  authors {
    types
    id
  }
}

fragment helpersSanitizedAuthorEntityIdsArticle on Article {
  authors {
    entityId
    id
  }
}

fragment helpersSectionContent on Section {
  fullSectionPath {
    entityId
    id
  }
}

fragment helpersStyleSectionContent on Section {
  fullSectionPath {
    entityId
    id
  }
}

fragment helpersUseContentSponsorContent on Content {
  __isContent: __typename
  topics {
    entityId
    sponsor {
      ...sponsorTagSponsor
      name
      type
      id
    }
    id
  }
  ... on Article {
    sponsorType
  }
  ...helpersCheckIsMainTopicContent
}

fragment hooksArticleDateUtilsContent on Content {
  __isContent: __typename
  createdDate
  publishedDate
  updatedDate
}

fragment hooksArticleSeoArticle on Article {
  ...helpersCheckIsPostMagazineArticle
  ...helpersCheckIsStyleArticle
  ...hooksContentHeadlineTagContent
  ...helpersCheckIsAmpEnabledArticle
  entityId
  headline
  socialHeadline
  types {
    value {
      entityId
      id
    }
  }
  authors {
    entityId
    id
  }
  images {
    generic_og: style(filter: {style: "og_image_scmp_generic"}) {
      url
    }
    styles(filter: {styles: ["og_postmag", "og_image_style", "og_image_scmp_analysis", "og_image_scmp_explainer", "og_image_scmp_editorial", "og_image_scmp_fact_check", "og_image_scmp_debate", "og_image_scmp_live", "og_image_scmp_obituary", "og_image_scmp_opinion", "og_image_scmp_review", "og_image_scmp_series", "og_image_scmp_generic"]}) {
      url
      style
    }
    type
  }
  urlAlias
}

fragment hooksContentHeadlineTagContent on Content {
  __isContent: __typename
  __typename
  ... on Article {
    types {
      value {
        name
        entityId
        description {
          text
        }
        id
      }
    }
    ...helpersCheckIsStyleArticle
  }
  flag
  sectionsV2 {
    value {
      __typename
      ... on Section {
        name
      }
      ... on VideoSection {
        name
      }
      ... on Node {
        __isNode: __typename
        id
      }
    }
  }
  ...hooksContentHelperContent
}

fragment hooksContentHelperContent on Content {
  __isContent: __typename
  ...helpersSanitizeArticleTypeEntityIdsArticle
  ...helpersSanitizeAuthorTypesArticle
  ...helpersSanitizedAuthorEntityIdsArticle
  flag
}

fragment hooksInlinePlusWidgetContent on Content {
  __isContent: __typename
  topics {
    entityId
    id
  }
}

fragment hooksPaywallPromiseContent on Content {
  __isContent: __typename
  entityId
}

fragment hooksTrackPageViewArticle on Content {
  __isContent: __typename
  entityId
  publishedDate
  headline
  sectionsV2 {
    value {
      __typename
      ... on Section {
        name
      }
      ... on Node {
        __isNode: __typename
        id
      }
    }
  }
  urlAlias
  authors {
    name
    id
  }
  entityUuid
}

fragment imageContent on Content {
  __isContent: __typename
  headline
  ...checkersCheckContentContainsStarlingImageContent
}

fragment inlineWidgetContent on Content {
  __isContent: __typename
  ...contentNewsletterWidgetContent
}

fragment mainImagePrintArticleArticle on Article {
  images {
    title
    url
    isSlideshow
    size_652x446: style(filter: {style: "652x446"}) {
      url
    }
  }
}

fragment photoGalleryDialogContent on Content {
  __isContent: __typename
  __typename
  ...contentShareWidgetContent
}

fragment photoGalleryWidgetContent on Content {
  __isContent: __typename
  ...photoGalleryDialogContent
}

fragment scmpYoutubeContent on Content {
  __isContent: __typename
  entityId
  urlAlias
  publishedDate
}

fragment sponsorTagSponsor on Sponsor {
  name
  type
  images {
    url
  }
}


types

sectionsV2

disableOffPlatformContent

sponsorType

published

headline

socialHeadline

authors

images

publishedDate

updatedDate

summary

subHeadline

keywords

topics

readingTime

authorLocations

Anthea Rowan

This is the 13th instalment in a series on dementia, including the research into its causes and treatment, advice for carers, and stories of hope.
My mother’s ACB score is displayed in big, bold, fire-engine red letters beneath the list of prescription drugs I have input to calculate it.
ACB stands for “anticholinergic cognitive burden”. I only thought to explore anticholinergic drugs, what they are, their effects, and which ones my mother may be, and have been, on, when a doctor remarked on the dementia risk of sleeping tablets.
“Many sleep aids are anticholinergic,” he said. “They disrupt a neurotransmitter in the brain called acetylcholine, which is essential for memory.”

The drugs that bear this AC burden and are responsible for stacking up that score in my mother’s case, include an anti-anxiety drug, an antidepressant and an antacid.
Drugs that affect acetylcholine often begin with “ant” or “anti”: antihistamine, anti-anxiety, antidepressant, antacid, antimuscarinic (used to manage an overactive bladder) and more.
How the brain works and how to keep it healthier for longer
These drugs do not need to be taken for long before an effect manifests: one study found that drugs with strong anticholinergic effects – which are thought to be cumulative – had the potential to cause cognitive impairment when taken continuously for as short a period as 60 days.
Anticholinergic drugs – some of which are sold as OTC (over-the-counter) medicines – work by blocking the action of acetylcholine.
Acetylcholine has been called the “memory molecule” for the crucial role it plays in recall, learning and focus. It was one of the first neurotransmitters identified – about a century ago – and is one of the most abundant in our nervous system.
A typical early sign of insufficient amounts of acetylcholine might manifest as “senior moments”.

Another early symptom is loss of spatial awareness. (I remember feeling puzzled when my mother asked, ‘Now, where’s the bathroom again?’ How did she not know?)
Acetylcholine is imperative in the conversion of short-term memories to long-term ones, like a program to transfer data to an archive. It’s not just important because it helps us to learn, concentrate and stay mentally engaged; it also helps modulate REM sleep, emotion and even thirst.
Acetylcholine also enhances brain plasticity.
Age-related muscle loss: why it happens and how to deal with it
There is substantial research that points to the dementia risk of taking ACB drugs.
A study published in early 2015 found the most common ACB drugs included tricyclic antidepressants (an older generation antidepressant), first-generation antihistamines, and antimuscarinics.
A follow-up seven years later revealed that almost a quarter of the cohort that had been taking ACB drugs had developed dementia. The study pressed for an increase in awareness among health professionals about these risks. That same year, a medication to control her “irritable” bladder was added to my mother’s script. She was 75.
A 2018 study published in the BMJ suggests “a robust association between some classes of anticholinergic drugs and future dementia incidence”, a result observed from exposure 15 to 20 years before a diagnosis.

More recently, a 2019 study found such drugs carried “significant” dementia risk in an at-risk older population.
Did my mother’s doctor not know this when he added a drug to manage urinary incontinence to her antidepressant, anti-anxiety script? She certainly didn’t.
Acetylcholine levels decline as we age. And it’s in these advanced years that our physicians may see fit to prescribe drugs to boost mood or aid sleep or alleviate incontinence – Oxybutynin, say, which scores a maximum three on the ACB scale (the medication my mother was prescribed a decade ago).
Or something for a sluggish digestion, Ranitidine (with a burden of two), perhaps.

Of course these drugs have a place. But perhaps they don’t all have a place at the same time. Perhaps there are safer alternatives? Doctors need to be mindful of the risks they pose, especially to an already at-risk population: the over 65s.
According to the anticholinergic burden calculator – which uses two different scoring systems, the German Anticholinergic Burden score and the Anticholinergic Cognitive Burden Scale – a score of three+ is associated with increased cognitive impairment and mortality.
A study cited by the UK’s NHS found that 20 per cent of patients over 65 who scored four or more had died by the end of the two-year study period compared with 7 per cent of patients with a score of zero.
My mother’s ACB, based on current and past prescriptions, stands at seven. She has carried this burden for 45 years.
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Dementia and ACB scores: how common prescription and over-the-counter drugs raise the risk of memory loss and cognitive decline

Certain common drugs, including antihistamines, antacids, antidepressants and anti-anxiety medicines, can disrupt the neurotransmitter acetylcholine, dubbed the “memory molecule” increasing the risk of dementia. Photo: Shutterstock

The writer, Anthea Rowan, with her mother. Photo: Anthea Rowan

Taking medications that block the action of acetylcholine can lead to memory loss, problems with spatial awareness, and cognitive decline. Photo: Shutterstock

Studies have found that anticholinergic drugs carried “significant’ dementia risk” for the over-65s. Photo: Shutterstock

Doctors need to be mindful of the risks posed by anticholinergic drugs, especially to an already at-risk population: the over 65s. Photo: Shutterstock

Lifestyle

Health & Wellness

Health

Family & Relationships

Common drugs that disrupt the ‘memory’ neurotransmitter acetylcholine include antihistamines, antacids, antidepressants and anti-anxiety medicines
These drugs, whose negative effects are cumulative, increase the risk of dementia, memory loss and reduced spatial awareness – expressed as an ACB score


Taking common drugs, including antidepressants, antihistamines and sleeping pills, for as little as 60 days can affect memory, cognitive ability and spatial awareness by disrupting the neurotransmitter acetylcholine.


Wellness

Dementia

Ageing society

Medicine