Summary
Integrity of central cholinergic neurotransmission is essential for adequate cognitive functioning. Many psychotherapeutic medications have anticholinergic side-effects. In order to determine the impact of circulating anticholinergic activity on cognitive performance, 28 geropsychiatric inpatients underwent cognitive testing at different levels of anticholinergic serum activity. In 10 subjects with a diagnosis of probable Alzheimer's disease, significant deterioration of selected cognitive functions was observed at anticholinergic serum levels that caused no dysfunction in the 18 non-demented subjects. The data suggest that non-demented elderly patients with psychiatric problems tolerate psychotropic pharmacotherapy without significant negative impact on their cognitive competency. By contrast, patients with Alzheimer's disease are at risk of additional impairment. The introduction of anticholinergic serum activity as a monitoring technique for safe psychopharmacotherapy in geriatric patients is discussed.
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References
Bartus RT, Dean RL, Beer B, Lippa AS (1982) The cholinergic hypothesis of geriatric memory dysfunction. Science 217: 408–417
Battig W, Montague N (1969) Category norms for verbal items in 56 categories. J Exp Psychol Monogr 80: 1–43
Buschke H (1973) Selective reminding for analysis of memory and learning. J Verb Learn Verb Behav 12: 543–550
Corkin S (1981) Acetylcholine, aging, and Alzheimer's disease. Trends Neurol Sci 4: 287–290
Davies P (1977) Cholinergic mechanisms in Alzheimer's disease. Br J Psychiatry 131: 318–319
Davies RK, Tucker GJ, Harrow M, Detre TP (1971) Confusional episodes and antidepressant medication. Am J Psychiatry 128: 95–99
Drachman DA (1977) Memory and cognitive function in man: does the cholinergic system have a specific role? Neurology 27: 783–790
Drachman DA, Leavitt J (1974) Human memory and the cholinergic system. Arch Neurol 30: 113–121
Folstein MF, Folstein SE, McHugh PR (1975) Mini-Mental State: a practical method for grading the cognitive state of patients for the clinician. J Psychiatr Res 12: 189–198
Freeman RL, Galaburda AM, Cabal RD, Geschwind N (1985) The neurology of depression. Arch Neurol 42: 289–291
Goyal RK (1989) Muscarinic receptor subtypes. Physiology and clinical implications. N Engl J Med 321: 1022–1029
McAllister TW (1982) Overview: pseudodementia. Am J Psychiatry 140: 528–533
McEvoy JP, McCue M, Spring B, Mohs RC, Lavori PW, Farr RM (1987) Effects of amantadine and trihexyphenidyl on memory in elderly normal volunteers. Am J Psychiatry 144: 573–577
McKhann G, Drachman D, Folstein, M, Katzman R, Price D, Stadlan EM (1984) Clinical diagnosis of Alzheimer's disease: report of the NINCDS-ADRDA work group under the auspices of Department of Health and Human Services Task Force on Alzheimer's Disease. Neurology 34: 485–490
Perlick D, Stastny P, Katz I, Mayer M, Mattis S (1986) Memory deficits and anticholinergic levels in chronic schizohrenia. Am J Psychiatry 143: 230–232
Perry EK, Tomlinson BE, Blessed G, Bergmann K, Gibson PH, Perry RH (1978) Correlation of cholinergic abnormalities with senile plaques and mental test scores in senile dementia. Br Med J 2: 1457–1459
Potamianos G, Kellett JM (1982) Anti-cholinergic drugs and memory: the effects of benzhexol on memory in a group of geriatric patients. Br J Psychiatry 140: 470–472
Reisberg B, Ferris SH, deLeon MJ, Crook T (1982) The Global Deterioration Scale for assessment of primary degenerative dementia. Am J Psychiatry 139: 1136–1139
Reynolds CR, Hoch CC, Kupfer DJ, Buysse DJ, Houck PR, Stack JA, Campbell DW (1988) Bedside differentiation of depressive pseudodementia from dementia. Am J Psychiatry 145: 1099–1103
Salzman C (1982) A primer on geriatric psychopharmacology. Am J Psychiatry 139: 67–72
Snyder S, Greenberg D, Yamamura HI (1974) Antischizophrenic drugs and brain cholinergic receptors. Arch Gen Psychiatry 31: 58–61.
Snyder SH, Yamamura HI (1977) Antidepressants and the muscarinic acetylcholine receptor. Arch Gen Psychiatry 34: 236–239
Squire LR, Welzel CO, Slater PC (1979) Memory complaints after ECT: assessment with a new self-rating instrument. Biol Psychiatry 14: 791–801
Sunderland T, Tariot PN, Cohen RM (1987) Anticholinergic sensitivity in patients with dementia of the Alzheimer type and age-matched controls. Arch Gen Psychiatry 44: 418–426
Thienhaus OJ, Thoene J, Allen A, Zemlan FP (in press) Anticholinergische Plasmaaktivität und kognitive Funktion in geriatrischen Patienten. Psychiatr Neurol Med Psychol
Tune L, Coyle JT (1981) Acute extrapyramidal side-effects: serum levels of neuroleptics and anticholinergics. Psychopharmacology 75: 9–15
Tune LE, Strauss ME, Lew MF, Breitlinger E, Coyle JT (1982) Serum levels of anticholinergic drugs and impaired recent memory in chronic schizophrenic patients. Am J Psychiatry 139: 1460–1462
Wells CE (1979) Pseudodementia. Am J Psychiatry 136: 895–900
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Thienhaus, O.J., Allen, A., Bennett, J.A. et al. Anticholinergic serum levels and cognitive performance. Eur Arch Psychiatry Clin Nuerosci 240, 28–33 (1990). https://doi.org/10.1007/BF02190089
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DOI: https://doi.org/10.1007/BF02190089