Abstract: Objective To identify high-risk drugs that can induce cognitive impairment, summarize their pathological mechanisms and clinical manifestations, and compare mainstream scales for the anticholinergic burden and inappropriate medication screening in elders so as to provide references for clinical screening of risks of medication. Methods Related guidelines, controlled clinical trials, and retrospective studies on drug-induced cognitive impairment published globally were retrieved. The mechanisms by which anticholinergic agents, sedative-hypnotics, anesthetics, and other medicines impaired cognitive function were summarized. The applicability, strengths and weaknesses of assessment tools, including the Anticholinergic Cognitive Burden (ACB) scale, the Beers Criteria, the STOPP/START criteria, and the Mini-Mental State Examination (MMSE), were compared. Results Anticholinergic agents were most likely to trigger cognitive impairment while polypharmacy could cause cumulative anticholinergic effects. Polypharmacy and patients' age were key contributors to cognitive impairment. The ACB scale was more correlated with clinical outcomes than other tools. Conclusion A range of commonly-used drugs can induce cognitive impairment, and elderly patients with polypharmacy are the most vulnerable. Clinicians are advised to adopt the ACB scale to quantify the anticholinergic burden, combine it with the Beers Criteria and STOPP/START to screen a variety of high-risk drugs, and intervene quickly to reduce the risks of drug-induced cognitive impairment.

Key words: Drug-Induced Cognitive Impairment (DICI), Anticholinergic Drugs, Risk Factors, Risk Assessment, Adverse Drug Reaction