OBJECTIVES: : Anticholinergic medications, though frequently used in the elderly population, are associated with cognitive impairment and use of these agents is a concern in dementia patients. This study examined the prevalence and predictors of anticholinergic prescribing in elderly outpatients with dementia. METHODS: Data from 2006–2007 National Ambulatory Medical Care Survey (NAMCS) and the outpatient National Hospital Ambulatory Medical Care Survey (NHAMCS) were combined to analyze elderly (65 years or older) patient visits for dementia (ICD-9-CM codes-290.XX, 291.2, 294.XX, 331.XX, 046.1 and 046.3). Anticholinergic drugs were identified using a preexisting scale, the Anticholinergic Drug Scale (ADS), which classified anticholinergic drugs into four levels in increasing order of their anticholinergic activity.  Descriptive analysis was used to evaluate prevalence patterns and multiple logistic regression was conducted to examine the factors associated with prescribing of medications with marked anticholinergic activity (Level 2 or Level 3).  RESULTS: :According to the 2006-2007 NAMCS and NHAMCS data, there were a total of 6.8 million (95% Confidence Interval (CI) 5.27-8.44 million, 0.32%) ambulatory care visits for dementia. Nearly 43% (95% CI 35.24%-50.48%) of all elderly dementia patient visits involved prescribing of at least one anticholinergic drug; 36.76% of the above visits involved Level 1 medications, 10.85% of visits involved Level 2 or Level 3 medications. While age (75-84 years; Odds Ratio (OR) 0.26, 95% CI0.08-0.85) and acetylcholine esterase inhibitor use (OR 0.21, 95% CI 0.07-0.65) increased the likelihood of prescribing medications with marked anticholinergic activity, total number of medications prescribed also (OR 1.41, 95% CI: 1.81-1.67) increased the likelihood of these prescriptions. CONCLUSIONS: :Over 10% of elderly dementia visits involved prescribing of medications with marked anticholinergic activity. Given the severe cognitive adverse events, there is strong need to optimize anticholinergic drug prescribing in elderly outpatients with dementia.