Anticholinergic Sensitivity in Patients With Dementia of the Alzheimer Type and Age-Matched Controls

Sunderland, Trey; Tariot, Pierre N.; Cohen, Robert M.; Weingartner, Herbert; Mueller, Edward A.; Murphy, Dennis L.

doi:10.1001/archpsyc.1987.01800170032006

Cited by 282 publications

(71 citation statements)

References 69 publications

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“…As a consequence, overall levels of vigilance may be more variable and less consistently reliable across studies than the vigilance decrement that is not affected by the same factors (e.g., Parasuraman, 1986;Poulton, 1977). Perhaps for this reason, our finding of decreased overall vigilance in patients with mild AD is consistent with some previous studies of vigilance in senile dementia (e.g., Alexander, 1973;Sahakian et al, 1989;Sunderland et al, 1987), but not with others (Lines et al, 1991;Nebes & Brady, 1993). The decreased overall performance in mild AD patients may partly reflect a greater perceptual difficulty, which might in turn be responsible for their greater sensitivity decrement over time on task.…”

supporting

confidence: 91%

Sustained Attention in Mild Alzheimer's Disease

Berardi¹,

Parasuraman²,

Haxby³

2005

Developmental Neuropsychology

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The vigilance decrement in perceptual sensitivity was examined in 10 patients with mild Alzheimer's disease (AD) and 20 age-matched controls. A visual high-event rate digit-discrimination task lasting 7.2 min. (six 1.2 min blocks) was presented at different levels of stimulus degradation. Previous studies have shown that sensitivity decrements (d′) over time at high-stimulus degradation result from demands on effortful processing. For all degradation levels, the overall level of vigilance (d′) was lower in AD patients than in controls. All participants showed sensitivity decrement over blocks, with greater decrement at higher degradation levels. AD patients exhibited greater sensitivity decrement over time at the highest degradation level they all could perform relative to control participants. There were no concomitant changes in either response bias (C) or response times. The results indicate that mild AD patients have overall lower levels of vigilance under conditions that require both automatic and effortful processing. Mild AD patients also exhibit a deficit in the maintenance of vigilance over time under effortful processing conditions. Although the sample of AD patients was small, results further suggest that both possible and probable AD patients had greater sensitivity decrement over time at the highest degradation level than did control participants, but only probable AD patients had lower overall levels of vigilance. In the possible AD patients as a group, the decrement in vigilance occurred in the absence of concurrent deficits on standard attentional tasks, such as the Stroop and Trail Making tests, suggesting that deficits in vigilance over time may appear earlier than deficits in selective attention.Alzheimer's disease (AD) is a progressive, degenerative brain disorder, the most usual and early clinical manifestation of which is memory impairment (Baddeley, Della Sala, Logie, & Spinnler, 1986;Morris & Kopelman, 1986). Attentional functions, particularly selective and divided attention, are also affected early in the course of AD (Parasuraman & Haxby, 1993). Although sustained attention has been less extensively studied, this aspect of attention is worthy of further investigation in relation to dementia, for several reasons. First, clinical observations indicate that demented patients have difficulty concentrating and fatigue easily (Lezak, 1995). Altered sustained attention in AD patients may also contribute to their deficits in other cognitive functions. Furthermore, everyday activities such as safe driving (Ball, 1997;Duchek, Hunt, Ball, Buckles, & Morris, 1997Hunt, Morris, Edwards, & Wilson, 1993; and prevention of falls (Buchner & Larson, 1987) may depend on intact maintenance of attention.Several different experimental paradigms have been used to investigate sustained attention, including signal detection (Bushnell & Rice, 1999), serial reaction (Robbins, 1998), responseRequests for reprints should be sent to Anna Maria Berardi, Department of Psychology, University of Metz, Ile du Sau...

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supporting

confidence: 91%

Sustained Attention in Mild Alzheimer's Disease

Berardi¹,

Parasuraman²,

Haxby³

2005

Developmental Neuropsychology

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“…89 Anticholinergic side effects from many antidepressants (particularly the tricyclic drugs) limit their usefulness in AD, as cognitive deficits may worsen on these medications. 87,90 Moclobemide, selective serotonin reuptake inhibitors (SSRIs), trazodone, nefazodone and venlafaxine are considered reasonable choices since they have minimal anticholinergic effects. 89 Trazodone may cause hypotension in high doses.…”

Section: Depression and Dementiamentioning

confidence: 99%

The Recognition, Assessment and Management of Dementing Disorders: Conclusions from the Canadian Consensus Conference on Dementia

Patterson

Grek

Gauthier

et al. 2001

Can. J. Neurol. Sci.

122

119

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To develop evidence based consensus statements on which to build clinical practice guidelines for primary care physicians towards the recognition, assessment and management of dementing disorders; ii) to disseminate and evaluate the impact of these statements and guidelines built on these statements. O p t i o n s : Structured approach to assessment, including recommended laboratory tests, choices for neuroimaging and referral; management of complications (especially behaviour problems and depression) and use of cognitive enhancing agents. Potential outcomes: Consistent and improved clinical care of persons with dementia; cost containment by more selective use of laboratory investigations, neuroimaging and referrals; appropriate use of cognitive enhancing agents. E v i d e n c e : Authors of each background paper were entrusted to: perform a literature search, discover additional relevant material including references cited in retrieved articles; consult with other experts in the field and then synthesize information. Standard rules of evidence were applied. Based upon this evidence, consensus statements were developed by a group of experts, guided by a steering committee of eight individuals from the areas of Neurology, Geriatric Medicine, Psychiatry, Family Développer des énoncés consensuels basés sur les données actuelles de la science sur lesquels on puisse construire des lignes directrices cliniques pour les médecins de première ligne pour l'identification, l'évaluation et la prise en charge des patients déments; ii) diffuser et évaluer l'impact de ces énoncés et des lignes directrices basées sur ces énoncés. O p t i o n s : Une approche structurée pour l'évaluation, incluant les épreuves de laboratoire recommandées, les choix d'examens de neuroimagerie et de référence en spécialité; la prise en charge des complications (spécialement des problèmes de comportement et de dépression) et l'utilisation d'agents qui améliorent la fonction cognitive. Bénéfices potentiels: Des soins améliorés et fiables aux personnes démentes; un contrôle des coûts par une utilisation plus judicieuse des examens de laboratoire, de la neuroimagerie et de la référence en spécialité; une utilisation appropriée des agents qui améliorent la fonction cognitive. É v i d e n c e : Les auteurs de chaque article de fond ont reçu le mandat de faire une recherche de la littérature pour ajouter des informations pertinentes incluant les références citées dans ces articles; consulter d'autres experts dans ce domaine et faire une synthèse de l'information. Ces tâches ont été effectuées conformément aux normes de la preuve. Sur la foi de cette évidence, les énoncés consensuels ont été développés par un groupe d'experts, guidé par un comité de direction de huit individus des domaines de la neurologie, de la gériatrie, de la psychiatrie, de la médecine familiale, de la médecine préventive et des systèmes de santé. Va l e u r s : Des recommandations ont été développées en portant une attention particulière sur le contexte des soins de première ligne ...

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“…One study in India showed that, the median survival time determined to be 3.3 yrs for patients with dementia and 2.7 yrs for patients with AD [8]. Scopolamine, a nonselective muscarinic cholinergic antagonist, is a wellknown centrally acting cholinergic probe, which causes impairment in learning [9]. In addition, scopolamine also causes increase in cognitive impairment in healthy elderly subjects compared to young adults [10].…”

Section: Introductionmentioning

confidence: 99%