Study Links Schizophrenia Medicines’ Anticholinergic Impact to Risk of Cognitive Impairment
An important study led by BBRF grantees has closely examined a commonplace pharmacologic property of many antipsychotic and other medications commonly prescribed to people with chronic schizophrenia and has concluded that this property can "substantially" contribute to the risk of cognitive impairment.
consider swapping out one or more medications for others
total anticholinergic burden
reduce the total anticholinergic burden
and
potentially, the risk of cognitive impairment
computerized cognitive training intervention
reduced "anticholinergic burden-associated cognitive deterioration."
The researchers stressed that their results point to the total score—total anticholinergic burden—as being the key factor in contributing to risk for cognitive impairments, as opposed to any particular medication or medications considered individually.
tranquillizing agents such as benzodiazepines.
Many antipsychotic medications, both "first generation" agents like chlorpromazine and "second-generation" agents such as clozapine, have anticholinergic properties,
degree to which antipsychotics (and other psychiatric medications) block acetylcholine varies from medicine to medicine
Many have a small to moderate anticholinergic impact, but some have a comparatively large impact, as assessed by pharmacologists.
negative cumulative impact of anticholinergic medication exposure and suggested "strong and potentially causal associations between increased burden of anticholinergic medicines and both cognitive impairment and risk of dementia."
Risk of dementia associated with anticholinergic drugs for overactive bladder in adults aged ≥55 years: nested case-control study
Objective To investigate whether different anticholinergic drug treatments for overactive bladder have differential risks for incident dementia, in a large representative population of older adults in England.Design Nested case-control study.Setting General practices in England providing data to the Clinical Practice Research Datalink (CPRD) GOLD database, with linked patient admission records from secondary care (Hospital Episode Statistics), 1 January 2006 and 16 February 2022Participants 170 742 patients aged ≥55 years, with a first reported diagnosis of dementia during the study period, matched by age, sex, and general practice with 804 385 individuals without dementia (controls).Interventions Cumulative drug use (defined using total standardised daily dose) of different anticholinergic drugs used for the treatment of an overactive bladder, and a non-anticholinergic drug, mirabegron, in the period 3-16 years before a diagnosis of dementia (or equivalent date in matched controls).Main outcome measures Odds ratios for onset of dementia associated with the different anticholinergic drugs used for the treatment of an overactive bladder, adjusted for sociodemographic characteristics, clinical comorbidities, and use of other anticholinergic drug treatments.Results The study population comprised 62.6% women, and median age was 83 (interquartile range 77-87) years. 15 418 (9.0%) patients with dementia and 63 369 (7.9%) controls without dementia had used anticholinergic drugs for the treatment of an overactive bladder in the 3-16 years before diagnosis (or equivalent date for controls). The adjusted odds ratio for dementia associated with the use of any anticholinergic drug used to treat an overactive bladder was 1.18 (95% confidence interval (CI) 1.16 to 1.20), and was higher in men (1.22, 1.18 to 1.26) than women (1.16, 1.13 to 1.19). The risk of dementia was substantially increased with the use of oxybutynin hydrochloride (adjusted odds ratio 1.31, 95% CI 1.21 to 1.42 and 1.28, 1.15 to 1.43 for use of 366-1095 and 1095 total standardised daily doses, respectively), solifenacin succinate (1.18, 1.09 to 1.27 and 1.29, 1.19 to 1.39), and tolterodine tartrate (1.27, 1.19 to 1.37 and 1.25, 1.17 to 1.34). No significant increases in the risk of dementia associated with darifenacin, fesoterodine fumarate, flavoxate hydrochloride, propiverine hydrochloride, and trospium chloride were found. The association between mirabegron, a non-anticholinergic drug, and dementia was variable across the dose categories and might be caused by previous use of anticholinergic drugs for the treatment of an overactive bladder in these individuals.Conclusions Of the different anticholinergic drugs used to treat an overactive bladder, oxybutynin hydrochloride, solifenacin succinate, and tolterodine tartrate were found to be most strongly associated with the risk of dementia in older adults. This finding emphasises the need for clinicians to take into account the possible long term risks and consequences of the available treatment options for an overactive bladder in older adults, and to consider prescribing alternative treatments that might be associated with a lower risk of dementia.
risk of dementia was substantially increased with
oxybutynin
solifenacin succinate
tolterodine
No significant increases in the risk of dementia
darifenacin
fesoterodine
flavoxate
propiverine
trospium
association between mirabegron, a non-anticholinergic drug, and dementia was variable across the dose categories
most strongly associated with the risk of dementia in older adult
Anticholinergics: List, Side Effects, Uses, Warnings, and More
Anticholinergic drugs are used to treat many conditions, including chronic obstructive pulmonary disorder (COPD) and overactive bladder (OAB). Explore our list. Learn how they work, side effects, risks, and more.
symptoms of Parkinson’s disease
overactive bladder and incontinence
motion sickness
relax the person
decrease excessive sweating.
be extra careful not to become overheated
these drugs aren’t usually prescribed for older people.
Anticholinergics are known to cause confusion, memory loss, and worsening mental function in people who are older than 65 years.
hypertension (high blood pressure)
Anticholinergics can treat a variety of conditions, including:
urinary incontinence
overactive bladder (OAB)
Benadryl, Tylenol PM, Advil PM,
Dramamine)
oxybutynin (Ditropan XL)
tolterodine (Detrol)
antihistamine to be taken for allergies and as a sleep aid, diphenhydramine (Benadryl) also has anticholinergic effects
Trusted Source
involuntary muscle movements in the
urinary tract
salivation
digestion
urination
mucus secretion
decrease
involuntary muscle movement
digestion
mucus secretion
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How Cogentin Can Treat Parkinsonism Symptoms
Learn about Cogentin (benztropine), a drug sometimes used in people with bipolar disorder to treat drug-induced parkinsonism that can occur with bipolar medications.
Stiffness of the trunk, arms, or legs
Tremors
Slowed movement
used with caution
adults aged 65 or older
In large doses, this medication can result in mental confusion, excitement, or the weakness of or inability to move certain muscle groups.
Cogentin may interact with certain drugs, such as antipsychotic drugs and tricyclic antidepressants. In some cases, these interactions have been fatal.
Treatment Options for Acute Agitation in Psychiatric Patients: Theoretical and Empirical Evidence
Acute agitation is a common presenting symptom in the emergency ward and is also dealt with on a routine basis in psychiatry. Usually a symptom of an underlying mental illness, it is considered urgent and immediate treatment is indicated. The ...
anticholinergic
typical antipsychotic haloperidol (alone
in combination with antihistaminergic and anticholinergic drugs such as promethazine
benzodiazepines lorazepam, diazepam and midazolam
variety of atypical antipsychotics
Haloperidol is associated with extrapyramidal symptoms (which can be controlled by co-administration of promethazine
may control agitation without inducing sedation
benzodiazepines have a more pronounced sedating activity
atypical antipsychotics aripiprazole and ziprasidone are better tolerated
olanzapine is also a powerful sedative
combination of haloperidol and promethazine, which combines the sedative properties of the antihistamine with the more selective calming action of haloperidol (with a reduced risk of extrapyramidal effects compared to haloperidol alone because of the anticholinergic properties of promethazine) may be the best choice based on empirical evidence.
Droperidol, ziprasidone, aripiprazole, and risperidone may be seen as second-line drugs
combination of haloperidol and an anticholinergic
An open-label study of amisulpride in the treatment of mania - PubMed
This first prospective study on amisulpride in the treatment of mania suggests that, despite the limitations of the open, observational design and small sample size, amisulpride may be effective and reasonably safe in the treatment of bipolar mania. D(2) and D(3) antagonism may be involved in the me …
The Development and Course of Bipolar Spectrum Disorders: An Integrated Reward and Circadian Rhythm Dysregulation Model
In this article, we present and review the evidence for two major biopsychosocial theories of the onset and course of bipolar spectrum disorders (BSDs) that integrate behavioral, environmental, and neurobiological mechanisms: the reward ...
Sacral Neuromodulation: Device Improvement and Current Applications in Urology
Sacral neuromodulation (SNM) offers a therapeutic approach to urological patients suffering from idiopathic overactive bladder (OAB) syndrome, with or without incontinence and non-obstructive urinary retention (NOR), who are not responding to or are ...
Sacral neuromodulation outcomes for the treatment of refractory idiopathic detrusor overactivity stratified by indication: Lack of anticholinergic efficacy versus intolerability
Patients may fail oral overactive bladder therapies due to either poor drug efficacy or intolerability. We determined if the success of sacral neuromodulation varies if performed secondary to lack of anticholinergic efficacy versus drug ...
Urinary Incontinence due to Overactive Detrusor Muscle: A Rare Side Effect of Venlafaxine
We report a case of reemergence of urinary incontinence (UI) in a patient with benign prostatic hyperplasia (BPH) after starting treatment with venlafaxine who was stabilized on tamsulosin and finasteride for about 6 years. A 66-year-old Caucasian ...
These 17 Medications May Harm Your Eyes
Tamsulosin (Flomax) helps people urinate when they have an enlarged prostate.
Chlorpromazine (Thorazine) is an antipsychotic medication can cause:Retinal damage (retinal degeneration). Thioridazine (Mellaril) is a similar antipsychotic that can also cause these symptoms
Tamsulosin (Flomax) for urinary obstruction from enlarged prostate puts you at risk of developing intraoperative floppy iris syndrome during cataract surgery.
Prednisone and other steroids can treat many medical conditions, including eye conditions like uveitis. But some people can develop elevated eye pressure while taking this medication. This causes steroid-induced glaucoma,
Benadryl A serious side effect some people develop is acute angle-closure glaucoma, which is a medical emergency. Acute angle-closure glaucoma causes permanent vision loss if it’s not treated right away
Chlorpromazine can cause:
Modulation of histone deacetylase, the ubiquitin proteasome system, and autophagy underlies the neuroprotective effects of venlafaxine in a rotenone-induced Parkinson's disease model in rats
[LInked article: "HDAC inhibitors have shown effectiveness against T-cell lymphomas but have limited activity against solid tumors. Combination strategies with other anticancer compounds are being explored for future clinical studies."
Unsuccessful Progression of Sacral Neuromodulation From the Evaluation to the Implantation Stage: A Single-Center Experience
Introduction Over the years, sacral neuromodulation (SNM) has become an established and effective treatment for chronic urinary system retention and incontinence. The process of SNM is performed in two stages, the first is an evaluation phase and ...
