Influence of Anticholinergic Activity in Serum on Clinical Symptoms of Alzheimer’s Disease

Abstract

Alzheimer’s disease (AD) is well known as a disease characterized by degeneration of cholinergic neuronal activity in the brain. It follows that patients with AD would be sensitive to an ‘anticholinergic burden’, and also that medicine with anticholinergic properties would promote various clinical symptoms of AD. Despite the relevance of this important phenomenon to the clinical therapeutics of AD patients, few reports have been seen concerning the relationship between anticholinergic burden and clinical AD symptoms. Therefore, we wished to investigate the relationship between serum anticholinergic activity (SAA) and the severity of clinical symptoms of AD patients. Twenty-six out of 76 AD patients referred by practitioners to our hospital were positive for anticholinergic activity in their serum, and the remaining 50 patients were negative. Cognitive and psychiatric symptoms in AD patients were compared between the positive SAA (SAA+) group and the negative SAA (SAA–) group. The SAA+ group showed a significantly (p < 0.05) lower total score on the Mini-Mental State Examination, and significantly (p < 0.05) higher scores on the Functional Assessment Staging and the Behavioral Pathology in Alzheimer’s Disease Rating Scale (BEHAVE-AD). In particular, certain subscales of the BEHAVE-AD, i.e. the items of paranoid and delusional ideation, hallucinations and diurnal rhythm disturbances, had higher scores in the SAA+ group. Moreover, it was shown that many more psychotropic medicines were prescribed to the SAA+ group. By means of logistic regression analysis, the items of paranoid and delusional ideation and diurnal rhythm disturbances in the BEHAVE-AD were positively correlated with SAA in patients. We hypothesized that SAA in AD patients would be associated with clinical symptoms, especially delusion and diurnal rhythm disturbances.

Memantine Abolishes Anticholinergic Activity in Patient with Alzheimer’s Disease at Moderate Stage

“…Recently, it has been suggested that AA might appear not only with exogenous manner, but also with an endogenous manner and AA appeared by means of inflammation [8] and mental stress [9]. We reported a positive relationship between SAA and clinical symptoms of AD patients [1,2]. Among 76 AD patients, 26 AD patients were positive for SAA [SAA (+)], the mean SAA value in the SAA (+) group was 4.14 ± 2.70 nM and the remaining 50 patients were negative [SAA (-)].…”

“…We already reported that anticholinergic activity (AA) can occur endogenously in patients with Alzheimer's Disease (AD) [1]. Since there is a possibility that AA might accelerate the pathologic changes of AD (amyloid plaques and tau protein) [2], it is important to establish treatment for abolishing AA.…”

Association Between Serum Anticholinergic Activity and Psychiatric Symptoms of Chronic Schizophrenia

“…SAA is considered to be an indicator of net anticholinergicity, combining the effects of anticholinergic agents and endogenous anticholinergic activity 13 . Our results suggest that among patients with schizophrenia, elevated SAA may indicate and predict an inhibitory effect on the extrapyramidal motor symptoms except for involuntary movements.…”

“…The relationship between atropine concentration and 3 H -QNB counts was linear for atropine concentrations ranging from 1.95 pmol / ml to 25 pmol / ml. Participants with SAA levels greater than 1.95 pmol / ml were de ned as SAA positive 13 .…”

Is anticholinergic activity related with Parkinson's disease?

“…5 Moreover, we have also reported the possibility that AA appeared endogenously in Alzheimer's patients. 6 Therefore, it is possible that AA could accelerate the pathology of PD. As such, we believe that in PD or LBD AA also appears endogenously and accelerates the PD pathology, increasing Lewy bodies.…”