Cognitive impact of anticholinergic medication in MS: Adding insult to injury?

Cruce, Roxana; Vosoughi, Reza; Freedman, Mark S.

doi:10.1016/j.msard.2012.05.002

Cited by 18 publications

(9 citation statements)

References 74 publications

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“…Non-selective drugs with anticholinergic effects have been suggested to have anticognitive effects in uncontrolled studies in patients with multiple sclerosis. 39 A significant anticognitive effect was not observed in this trial at doses exceeding existing standard recommendations.…”

Section: Discussionmentioning

confidence: 55%

Clemastine fumarate as a remyelinating therapy for multiple sclerosis (ReBUILD): a randomised, controlled, double-blind, crossover trial

et al. 2017

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Section: Discussionmentioning

confidence: 55%

Clemastine fumarate as a remyelinating therapy for multiple sclerosis (ReBUILD): a randomised, controlled, double-blind, crossover trial

et al. 2017

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“…Finally, MS medications may also affect patients' cognitive abilities and thus consideration should be given to potential disease-independent changes in cognitive performance when administering neuropsychological testing to this patient population. For example, anticholinergic drugs may cause cognitive deterioration in attention, processing speed, and verbal memory [93].…”

Section: Cognitive Symptomsmentioning

confidence: 99%

Temperature sensitivity in multiple sclerosis: An overview of its impact on sensory and cognitive symptoms

et al. 2018

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Multiple sclerosis (MS) is an autoimmune neurodegenerative disease characterized by demyelination of the central nervous system (CNS). The exact cause of MS is still unknown; yet its incidence and prevalence rates are growing worldwide, making MS a significant public health challenge. The heterogeneous distribution of demyelination within and between MS patients translates in a complex and varied array of autonomic, motor, sensory and cognitive symptoms. Yet a unique aspect of MS is the highly prevalent (60-80%) temperature sensitivity of its sufferers, where neurological symptoms are temporarily exacerbated by environmental-or exercise-induced increases (or decreases) in body temperature. MS temperature sensitivity is primarily driven by temperature-dependent slowing or blocking of neural conduction within the CNS due to changes in internal (core) temperature; yet changes in skin temperature could also contribute to symptom exacerbation (e.g. during sunlight and warm ambient exposure). The impact of temperature sensitivity, and particularly of increases in core temperature, on autonomic (e.g. thermoregulatory/cardiovascular function) and motor symptoms (e.g. fatigue) is well described. However, less attention has been given to how increases (and decreases) in core and skin temperature affect sensory and cognitive symptoms. Furthermore, it remains uncertain whether changes in skin temperature alone could also trigger worsening of symptoms. Here we review the impact of temperature sensitivity on MS sensory and cognitive function and discuss additional factors (e.g. changes in skin temperature) that potentially contribute to temperature-induced worsening of symptoms in the absence of alteration in core temperature.

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“…Anticholinergic medications used on a chronic basis to treat overactive bladder significantly reduce information processing speed and some memory functions. 143 …”

Section: Introductionmentioning

confidence: 99%

Recommendations for cognitive screening and management in multiple sclerosis care

et al. 2018

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Purpose:To promote understanding of cognitive impairment in multiple sclerosis (MS), recommend optimal screening, monitoring, and treatment strategies, and address barriers to optimal management.Methods:The National MS Society (“Society”) convened experts in cognitive dysfunction (clinicians, researchers, and lay people with MS) to review the published literature, reach consensus on optimal strategies for screening, monitoring, and treating cognitive changes, and propose strategies to address barriers to optimal care.Recommendations:Based on current evidence, the Society makes the following recommendations, endorsed by the Consortium of Multiple Sclerosis Centers and the International Multiple Sclerosis Cognition Society:Increased professional and patient awareness/education about the prevalence, impact, and appropriate management of cognitive symptoms.For adults and children (8+ years of age) with clinical or magnetic resonance imaging (MRI) evidence of neurologic damage consistent with MS:As a minimum, early baseline screening with the Symbol Digit Modalities Test (SDMT) or similarly validated test, when the patient is clinically stable;Annual re-assessment with the same instrument, or more often as needed to (1) detect acute disease activity; (2) assess for treatment effects (e.g. starting/changing a disease-modifying therapy) or for relapse recovery; (3) evaluate progression of cognitive impairment; and/or (4) screen for new-onset cognitive problems.For adults (18+ years): more comprehensive assessment for anyone who tests positive on initial cognitive screening or demonstrates significant cognitive decline, especially if there are concerns about comorbidities or the individual is applying for disability due to cognitive impairment.For children (<18 years): neuropsychological evaluation for any unexplained change in school functioning (academic or behavioral).Remedial interventions/accommodations for adults and children to improve functioning at home, work, or school.

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Cognitive impact of anticholinergic medication in MS: Adding insult to injury?

Cited by 18 publications

References 74 publications

Clemastine fumarate as a remyelinating therapy for multiple sclerosis (ReBUILD): a randomised, controlled, double-blind, crossover trial

Clemastine fumarate as a remyelinating therapy for multiple sclerosis (ReBUILD): a randomised, controlled, double-blind, crossover trial

Temperature sensitivity in multiple sclerosis: An overview of its impact on sensory and cognitive symptoms

Recommendations for cognitive screening and management in multiple sclerosis care

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