Editorial: Veterinary teaching in 2025: where we are and where we expect to go.

Many medications – including antidepressants, anxiolytics, antihistamines, antiparkinsonian agents, antipsychotics, and gastrointestinal drugs – contain components with anticholinergic properties and are widely prescribed to older adults . These drugs have been associated with adverse outcomes such as cognitive impairment, falls, fractures, and delirium . To comprehensively assess the cumulative effects of these agents, several anticholinergic burden scales have been developed and applied in both clinical research and practice, including the anticholinergic drug scale (ADS) , Drug Burden Index (DBI) , and anticholinergic cognitive burden (ACB) scale . Recently, the Japanese anticholinergic risk scale (JARS) was developed to reflect prescribing patterns specific to older adults in Japan . The impact of anticholinergic burden on physical function is considered indirect, involving multiple pathways. Reduced skeletal muscle mass and muscle quality are commonly associated with muscle weakness, which is a key risk factor for falls and fractures in older individuals . Anticholinergic drugs may be linked to poorer physical performance through plausible indirect pathways, including cognitive symptoms, mood changes, and reduced physical activity. Furthermore, an increased anticholinergic burden has also been linked to progression toward long-term care dependency . These observations suggest that quantitative assessment of anticholinergic burden may help identify older adults with a higher likelihood of functional decline and/or frailty and may inform preventive and rehabilitative efforts, while acknowledging that causal pathways remain to be clarified. Most existing studies have reported fragmented findings related to functional indicators such as grip strength, gait speed, Timed Up and Go (TUG) test results, and activities of daily living (ADLs) . In contrast, quantitative evidence linking anticholinergic burden to quantitative and structural muscle parameters remains very limited . In this scoping review, we aimed to systematically map the current literature on the quantitative relationship between anticholinergic burden and skeletal muscle parameters (mass, quality, and strength), physical function, and ADL in older adults, to map current evidence, identify gaps in knowledge, generate insights for clinical applications, and propose directions for future research.