<p dir="ltr">Over 50% of ambulatory older adults administer at least one anticholinergic medication. Older adults may be more susceptible to the adverse effects of anticholinergic medications, and there is evidence showing an association between anticholinergic exposure and increased risk of dementia. The primary objective of this research is to assess the impact of one-year of prescriptions for strong anticholinergics, with a score of 2 or 3 on the Anticholinergic Cognitive Burden (ACB) Scale, on cognitive measures indicative of dementia, followed by a comparative assessment of the relative impact of medication classes with anticholinergic activity.</p><p dir="ltr">The study utilizes a retrospective observational design to evaluate the relationship between anticholinergic medication prescriptions and cognitive measures. We used one-year EMR prescription data gleaned from R2D2 and BrainSafe clinical trials’ participants prior to baseline for the exposure variable along with the cognitive measures captured at the baseline visit. Total Standardized Daily Dose (TSDD) was computed from prescription records to quantify exposure to strong anticholinergics. Generalized Linear Models and Least Square means with Tukey’s adjustment were computed to detect the relationship between anticholinergic TSDD and anticholinergic medication classes and cognitive measures in multiple models.</p>