OBJECTIVES: Anticholinergic usage is controversial in patients diagnosed with dementia due to increased risk of cognitive impairment and psychosis in this population. Yet the extent of anticholinergic drug use in Singapore General Hospital’s patient population is unknown. This study aims to determine the prevalence of anticholinergic drug use in older patients with dementia and evaluate the association between its use with mortality and morbidity outcomes in these patients. METHODS: This is a retrospective cross-sectional analysis of patients aged 65 or older with dementia with at least one admission in 2013 (n = 460). Identified subjects were followed up prospectively for one year after first admission in 2013 for morbidity and mortality events. Data on exposure to anticholinergic drugs three months prior to admission were collected. Anticholinergic burden was determined using the Anticholinergic Drug Scale (ADS).  RESULTS: Most of the patients were female, Chinese with a mean age of 80.8 ± 8.4. Overall prevalence of anticholinergic drug use was 55.9% (n = 257). ADS level 1 drugs were most commonly prescribed (n = 234, 50.9%). Following this, ADS level 3 drug use was more prevalent (n = 73, 15.9%) than ADS level 2 drugs (n = 1, 0.2%). No association between anticholinergic drug use and mortality was found. However, it was significantly with associated morbidity outcomes. CONCLUSIONS: Anticholinergic drug use in patients with dementia is common. This may have contributed to increased morbidity for these patients. Prescribers and pharmacists should work together to monitor and optimize anticholinergic drug use in these patients.