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Seminars in Clinical Neuropsychiatry Apr 2000This article will briefly review the clinical studies focusing on measurement of serum levels of anticholinergic activity in delirious states. Three experimental... (Review)
Review
This article will briefly review the clinical studies focusing on measurement of serum levels of anticholinergic activity in delirious states. Three experimental approaches have been taken. First, to identify medications currently prescribed that have subtle anticholinergic effects. The current "list" includes 48 commonly prescribed medications. Second, to associate serum anticholinergic activity with delirium in various clinical states including postcardiotomy delirium, postelectroconvulsive delirium, delirious elderly medical inpatients, and nursing home patients. Third, to intervene in patients with elevated anticholinergic activity by reducing known anticholinergics and correlating this reduction with clinical measures of cognition and delirium. Our most recent data investigate the impact of anticholinergics on demented patients. Prevalence of delirium was significantly higher in patients receiving larger numbers of anticholinergics.
Topics: Acetylcholine; Aged; Cholinergic Antagonists; Delirium; Humans; Risk Factors
PubMed: 10837103
DOI: 10.153/SCNP00500149 -
American Family Physician Sep 2019
Review
Topics: Administration, Cutaneous; Cholinergic Antagonists; Glycopyrrolate; Humans; Hyperhidrosis
PubMed: 31524358
DOI: No ID Found -
Journal of Psychosocial Nursing and... Jun 2009Acetylcholine is a neurotransmitter that is important for communication between neurons and muscle, is involved in direct neurotransmission in the autonomic... (Review)
Review
Acetylcholine is a neurotransmitter that is important for communication between neurons and muscle, is involved in direct neurotransmission in the autonomic parasympathetic nervous system, and has been implicated in cognitive processing, arousal, and attention in the brain. The cholinergic-adrenergic hypothesis of mood disorders states that a given affective state might represent a balance between central cholinergic and adrenergic neurotransmitter activity in those areas of the brain regulating moods. According to this hypothesis, depression would be the clinical manifestation of a state of cholinergic dominance, whereas mania would reflect adrenergic dominance. On the basis of this hypothesis, anticholinergic drugs have been investigated as potential treatments for depression, but study results have not shown consistent antidepressant effects. However, the dosage dependency of scopolamine's effect across different studies and the lack of antidepressant effects with other anticholinergic drugs suggest that a specific muscarinic receptor subtype might be most relevant to the potential antidepressant mechanism of action of anticholinergic drugs.
Topics: Antidepressive Agents; Biperiden; Cholinergic Antagonists; Depressive Disorder; Humans; Muscarinic Antagonists; Nicotinic Antagonists; Scopolamine
PubMed: 19585799
DOI: 10.3928/02793695-20090508-01 -
Journal of Alzheimer's Disease : JAD 2015Drugs that block muscarinic cholinergic neurotransmission in the brain can, as a consequence, increase the formation of amyloid-β, and decrease brain levels of... (Review)
Review
Drugs that block muscarinic cholinergic neurotransmission in the brain can, as a consequence, increase the formation of amyloid-β, and decrease brain levels of phosphatidylcholine (by slowing its synthesis and accelerating its turnover). Both of these effects might cause a decrease in brain synapses, as characterizes and probably underlies the memory disorder of early Alzheimer's disease.
Topics: Alzheimer Disease; Amyloid beta-Peptides; Animals; Brain; Cholinergic Antagonists; Humans; Phosphatidylcholines
PubMed: 26402628
DOI: 10.3233/JAD-150290 -
Respiratory Medicine Jun 2017Acute bronchodilator response (BDR) is a potential phenotypic characteristic of COPD. However, the clinical factors associated with BDR in patients with COPD remain... (Comparative Study)
Comparative Study
BACKGROUND
Acute bronchodilator response (BDR) is a potential phenotypic characteristic of COPD. However, the clinical factors associated with BDR in patients with COPD remain unclear, particularly for BDR to anticholinergic agents.
OBJECTIVES
We aimed to clarify the clinical factors associated with BDR to β2-agonist and/or anticholinergic agent, considering time-associated variations of BDR. We also evaluated the association between BDR and clinical course of COPD.
METHODS
We analyzed 152 subjects who participated in the Hokkaido COPD cohort study. We repeatedly measured BDR to salbutamol (400 μg) or oxitropium (400 μg) three times for each every 6 months alternately over 3 years. Reversibility was defined by ≥ 12% and ≥200 mL increase in FEV over baseline. All subjects were classified into three groups based on the BDR stability; consistently reversible, consistently irreversible, and inconsistent. We compared baseline clinical characteristics and the 5-year clinical course of COPD among the three groups.
RESULTS
For either agent, the mean blood eosinophil count was significantly higher in those with consistently reversible than those with consistently irreversible (p < 0.05). The subjects with consistently reversible to oxitropium (p < 0.05), but not to salbutamol (p = 0.56), showed increased risk of exacerbation compared with the other two groups.
CONCLUSION
We identified the distinct clinical characteristics of COPD associated with acute BDR status. Increased cholinergic airway tone, which is reflected in the higher BDR only to anticholinergic agent, but not to β2-agonist, may be associated with exacerbation in COPD.
Topics: Administration, Inhalation; Adrenergic beta-2 Receptor Agonists; Aged; Aged, 80 and over; Albuterol; Bronchodilator Agents; Cholinergic Antagonists; Cohort Studies; Disease Progression; Eosinophils; Female; Forced Expiratory Volume; Humans; Japan; Male; Phenotype; Pulmonary Disease, Chronic Obstructive; Risk Assessment; Scopolamine Derivatives
PubMed: 28502414
DOI: 10.1016/j.rmed.2017.04.005 -
The Consultant Pharmacist : the Journal... Aug 2012To review the current literature assessing the risks associated with the use of anticholinergic (AC) medications in older adults and to provide recommendations for... (Review)
Review
OBJECTIVE
To review the current literature assessing the risks associated with the use of anticholinergic (AC) medications in older adults and to provide recommendations for pharmacists to incorporate the evaluation of AC burden as a component of a medication therapy management program for older adults.
DATA SOURCES
A MEDLINE/PubMed search was conducted from January 1990 to July 2011 using the terms anticholinergic, antimuscarinic, geriatric, aged, and elderly. References cited in studies and reviews identified in this search were also evaluated. Articles published in languages other than English or conducted in nonhuman species were not evaluated.
STUDY SELECTION
Studies and reviews were included if they evaluated adverse events associated with the use of AC medications in the older adult population.
DATA EXTRACTION
Data were extracted by the method of independent extraction by multiple observers based on their selection of sections.
DATA SYNTHESIS
The review presents evidence that AC medications are associated with negative outcomes in older adults and the importance of health care provider interventions to avoid these consequences.
CONCLUSION
AC burden is associated with adverse drug events and negative health outcomes in older adults. Health care providers should carefully assess the risks versus benefits of using medications with AC properties to minimize AC burden and prevent adverse outcomes in this vulnerable patient population. AC burden should be considered as acomponent of a medication therapy management program for seniors.
Topics: Age Factors; Aged; Cholinergic Antagonists; Humans; Medication Therapy Management; Pharmaceutical Services; Pharmacists; Professional Role
PubMed: 22910177
DOI: 10.4140/TCP.n.2012.564 -
Movement Disorders : Official Journal... 2002
Review
Topics: Cholinergic Antagonists; Cross-Over Studies; Humans; Parkinson Disease; Psychomotor Performance; Randomized Controlled Trials as Topic
PubMed: 12211135
DOI: 10.1002/mds.5556 -
Psychiatry and Clinical Neurosciences Jan 2014All currently available antipsychotic drugs are the dopamine D2 receptor antagonists and are capable of producing extrapyramidal side-effects (EPS). Anticholinergic... (Review)
Review
All currently available antipsychotic drugs are the dopamine D2 receptor antagonists and are capable of producing extrapyramidal side-effects (EPS). Anticholinergic drugs are primarily used to treat EPS or prevent EPS induced by antipsychotics in the treatment of psychosis and schizophrenia. However, they can cause a variety of distressing peripheral side-effects (e.g. dry mouth, urinary disturbances, and constipation) and central adverse effects (e.g. cognitive impairment, worsening of tardive dyskinesia, and delirium). Disturbances in cognitive abilities are cardinal features of schizophrenia from its earliest phases and account for much of the functional disability associated with the illness. It is likely that long-term concomitant administration of anticholinergics exacerbates the underlying cognitive impairment in patients with schizophrenia and subsequently affects patients' quality of life. Thus, current treatment guidelines for schizophrenia generally do not recommend the prophylactic and long-term use of anticholinergics. However, the high use of long-term anticholinergic drugs with antipsychotics has been identified as an important issue in the treatment of schizophrenia in several countries. To assess the benefits and limits of anticholinergic use in psychosis and schizophrenia, this article will provide a brief review of the pharmacology and clinical profiles of anticholinergic drugs and will focus on their effects on cognitive function in schizophrenia, particularly during the course of the early phase of the illness. In addition, we will address the effects of discontinuation of anticholinergics on cognitive function in patients with schizophrenia and provide a strategy for adjunctive anticholinergic use in patients treated with long-acting injectable antipsychotics.
Topics: Antipsychotic Agents; Central Nervous System; Cholinergic Antagonists; Cognition; Delayed-Action Preparations; Drug Therapy, Combination; Humans; Peripheral Nervous System; Psychotic Disorders; Schizophrenia; Schizophrenic Psychology
PubMed: 24102938
DOI: 10.1111/pcn.12088 -
Alzheimer Disease and Associated... 2018We investigated the cross-sectional association between anticholinergics and cognitive function in persons aged ≥ 50 years. Participants underwent neurological...
We investigated the cross-sectional association between anticholinergics and cognitive function in persons aged ≥ 50 years. Participants underwent neurological examination, neuropsychological testing and were classified into two groups: Those taking (AC+, N = 51) versus not taking anticholinergics (AC−, N = 204). AC+ were comparable to AC− participants by age, sex and education. There was a trend for worse performance in all memory and most executive function tests for AC+, but only the difference in the Paced Auditory Serial Attention Task 2 was significant. There was no dose-effect relationship between anticholinergic use and cognitive test scores. Results were not impacted by APOE ε4 status. In conclusion, we observed a significant difference between AC+ and AC− groups in only one measure of executive function. Thus anticholinergic medications do not appear to impact cognition in this relatively younger sample of late mid-life individuals. A longitudinal study is needed to confirm these findings.
Topics: Cholinergic Antagonists; Cognition; Cognitive Dysfunction; Cohort Studies; Cross-Sectional Studies; Female; Humans; Male; Middle Aged; Neuropsychological Tests
PubMed: 29481373
DOI: 10.1097/WAD.0000000000000251 -
Pharmacotherapy Feb 2003Inhaled anticholinergic drugs are considered one of the principal bronchodilator treatments for chronic obstructive pulmonary disease (COPD). Ipratropium bromide is an... (Clinical Trial)
Clinical Trial Randomized Controlled Trial Review
Inhaled anticholinergic drugs are considered one of the principal bronchodilator treatments for chronic obstructive pulmonary disease (COPD). Ipratropium bromide is an anticholinergic drug frequently administered for the treatment of COPD. Unfortunately, ipratropium has a short duration of action, requiring administration every 6 hours; this regimen affects adherence to drug therapy. Tiotropium bromide is structurally similar to ipratropium and is under development in the United States. The duration of action of tiotropium is approximately 24 hours, allowing for once-daily dosing. Other than xerostomia being more common with tiotropium than with ipratropium, the safety profiles of these drugs were similar in studied populations. On the basis of its improvements in trough spirometric measurements and improved pharmacokinetic profile compared with that of ipratropium, tiotropium is likely to become the first-line anticholinergic agent in the treatment of patients with COPD.
Topics: Administration, Inhalation; Cholinergic Antagonists; Drug Administration Schedule; Humans; Pulmonary Disease, Chronic Obstructive; Randomized Controlled Trials as Topic; Scopolamine Derivatives; Tiotropium Bromide
PubMed: 12587807
DOI: 10.1592/phco.23.2.183.32082