Post by norbert1 on Feb 8, 2005 14:48:00 GMT -5
From Merck Manual, Home edition - “Aging and Drugs”
Anticholinergic: What Does It Mean?
Anticholinergic effects are caused by drugs that block the action of acetylcholine. Acetylcholine is a neurotransmitter—a chemical messenger released by a nerve cell to transmit a nerve signal a neighboring nerve cell or a target cell in a muscle or gland. Acetylcholine stimulates smooth (involuntary) muscle cells, such as those in the heart or airways, to contract. Many commonly used drugs have anticholinergic effects. Most these drugs were not designed to produce these effects, which are therefore usually considered undesirable side effects. Anticholinergic effects include confusion, blurred vision, constipation, dry mouth, light-headedness, and difficulty with urination or loss of bladder control. However, anticholinergic drugs can also, for example, reduce tremors and nausea—both useful effects.
Older people are more likely to experience anticholinergic effects because the amount of acetylcholine in the body decreases with age. Consequently, anticholinergic drugs block a higher percentage of acetylcholine. Also, the aging body is less able to use what little acetylcholine is present.
---------------
My note-
People with alzheimers have an even lower level of acetylcholine, the neurotransmitter needed for thought. That is why Aricept is used in Alzheimers, to help retain the acetylcholine that is present. Drugs with anticholinergic properties will increase confusion and increase the tendency for psychotic thoughts (suspicions, delusions, and hallucinations.)
----------------------
from WebMD
Common Drugs May Raise Alzheimer's Risk
Finding in Parkinson's Patients Offers Hint of New Dementia Treatments
By Daniel DeNoon WebMD Medical News Archive
Reviewed By Brunilda Nazario, MD on Friday, July 25, 2003
July 25, 2003 -- Drugs often used by patients with Parkinson's disease may increase their risk of another killer brain disease: Alzheimer's.
The drugs -- called anticholinergic agents -- slow electrical impulses in nerve cells. They're used to help Parkinson's disease patients control unwanted movement such as tremors. These drugs also help with bladder control and dizziness. But other common drugs have anticholinergic activities, too. These include older allergy drugs and tricyclic antidepressants.
The report in the August issue of Annals of Neurology comes from Elaine K. Perry, PhD, senior scientist at University of Newcastle upon Tyne and colleagues. Perry's team examined the brains of deceased Parkinson's patients for the plaques and tangles seen in the brains of Alzheimer's patients.
The result: Those who took anticholinergic drugs for more than two years had significantly more plaque and tangles than those who never took the drugs. Taking the drugs for less than two years had no effect.
"What we saw were very, very low levels of Alzheimer's disease pathology, nothing like what you would see in Alzheimer's disease," Perry tells WebMD. "The drugs might increase this pathology, but they are not taking people into Alzheimer's disease."
But Allan Levey, MD, PhD, chair of the neurology department at Emory University School of Medicine, says these patients may have been on the way to Alzheimer's. Levey's commentary appears in the same issue of Annals of Neurology.
"If these people with Parkinson's disease had lived longer, they might have developed Alzheimer's disease," Levey tells WebMD.
Alzheimer's Risk in Widely Used Older Drugs
The category of drugs linked to Alzheimer's changes aren't now the front-line drugs for Parkinson's disease. One reason is that they can have terrible side effects. Medical students remember these side effects by learning a series of similes:
• "Mad as a hatter." Anticholinergic drugs can make patients delirious.
• "Blind as a bat." The drugs can dilate the pupils of the eye, making it hard to see.
• "Red as a beet." Flushing is a common side effect.
• "Dry as a bone." Dry skin is another side effect.
• "Hot as a hare." The drugs can cause overheating or hyperthermia.
Elderly patients are particularly likely to become confused when taking anticholinergic medicines. But the drugs are still widely used. And sometimes doctors aren't aware that other drugs their patients are taking have the same effects.
"The uglier perspective is all the drugs that have anticholinergic side effects," Levey says. "These are a lot of common medicines like antihistamines and the older antidepressants. And also we are talking about a worldwide problem, where many poorer nations don't have access to the more expensive new antidepressants."
Levey says the new findings don't prove anything. But they add another reason to prescribe these drugs with caution.
Perry also warns against jumping to conclusions.
"We cannot make any change to clinical practice based on one study," she says. "We need more studies before we can say, 'Be cautious about these drugs.' It is not right to start a panic in people taking these medicines."
But Levey says it can't hurt to talk this over with your doctor.
"Talk to your doctor about avoiding medicine with anticholinergic properties," he advises. "That's more because of the immediate effects, not because of new concerns about Alzheimer's disease. And if you need the medicines, don't worry about this."
Silver Lining: A Window on New Alzheimer's Treatments
There are also drugs that have the opposite effect of anticholinergic drugs. These compounds speed electrical impulses in nerve cells. Animal studies show that they can reduce plaques and tangles in the brain.
SOURCES: Annals of Neurology, August 2003. Elaine K. Perry, PhD, senior scientist, University of Newcastle upon Tyne, U.K. Allan Levey, MD, PhD, chair, department of neurology, Emory University School of Medicine, Atlanta.
---------------
And this article regarding Benadryl
“Anti Antihistamine” From AARP Bulletin, Oct 2004 pg12
Diphenhydramine is “best known under it’s brand name Benadry, is in a myriad of other over-the-counter medications including Exedrin PM, Nytol, Sleep-eve, sominex, Tylenol PM, and Unisom, to name just a handful.
For People age 60 and older, however, diphenhydramine is mostly bad news because it’s adverse effects are amplified in older people. A study in 2001 in the Archives of Internal Medicine found that a group of hospitalized patients 70 and older who were given the drug “had significantly increased risk of altered attention level, disorganized speech, change in consciousness and alertness, and behavioral disturbances,” according to lead author, Joseph Agostini, a professor at Yale University School of Medicine.
In the worse case, diphenhydramine can cause delirium and Hallucinations. What’s more, it often causes urinary retention, which can lead to urinary infections.
Geriatric specialists say the drug is not recommended for older patients.
Among other potential adverse effects of diphenhydramine are: dizziness or hypotinsion (low blood pressure), which dramatically increase the risk of falls; drowsiness; bowel problems (decreased motility), difficult or painful urination, dryness of mouth, nose or throat. Also: nervousness, restlessness, irritability and unusual excitement or nightmares.
Agnostini’s Assessmenti fo the drug as a sleep medication for an older person is blunt: “This is a horrible choice – I almost can’t think of anything worse.”
-----------------
My note - because of decreased levels of Acetycholine in people with Alzheimers and Lewy body, the effects of anti-cholinergic drugs on confusion and psychosis is even greater.
ANTICHOLINERGIC DRUGS
Tylenol PM (contains benadryl)
Anti-cholinergics (bladder control) Deltrol
Antispasmodics
antihistamines
Muscle relaxants (most)
narcotic pain relievers – codine, Oxycodone
Tricyclic antidepressants - Amitriptyline(Elavil, Endep, etc)
benzodiazepines for anxiety - Xanax, Valium, Ativan
Benzodiazepines for sleep (Barbituates)
conventional antipsychotics - Haldol
high doses of "mydriatic" class eye drops.
further References –
“Beer’s Criteria for Potentially Inappropriate Medication Use in the Elderly” by Sheila Molony - from the Try This series.
www.hartfordign.org/publications/trythis/issue16.pdf
The Merck Manual of Geriatrics, Chapter 6 Clinical Pharmacology,
www.merck.com/mrkshared/mm_geriatrics/sec1/ch6.jsp
Table 6-4 High Risk Drugs in the Elderly
www.merck.com/mrkshared/mm_geriatrics/tables/6t4.jsp
------------------
here's another article on this
From Yahoo health
au.health.yahoo.com/060201/3/ieqm.html
Drug side effects can mimic early dementia: study
LONDON (Reuters) - Common drugs used to treat depression, Parkinson's disease and allergies can produce side effects that can be mistaken for early dementia, scientists said on Wednesday.
They added that doctors should be aware the drugs, known as anticholinergics, can cause confusion, memory loss and disorientation and question patients about medication they are taking before prescribing drugs for early dementia.
"A large number of elderly people are taking medications that can mimic early dementia and are likely to be classed as having early dementia," said Karen Ritchie, of the Hopital La Colombiere in Montpellier, France.
There is no cure for Alzheimer's disease, the leading cause of dementia in the elderly. The main treatments for early dementia are pro-cholinergic drugs.
"We might find a large number of people in the rather ridiculous position of taking what we call pro-cholinergic medication to counteract anticholinergic drugs they are already taking," Ritchie said in an interview.
"A very large number of people with so-called early dementia have these effects due to drug consumption. The drugs they are taking are very common -- they include things like antihistamines," she added.
The researchers, whose findings are published online by the British Medical Journal, questioned 372 elderly people without dementia about the drugs they had taken and their past illnesses. Ten percent had used anticholinergic drugs for a long period.
After monitoring and assessing the patients for up to 8 years, the researchers found that people who had used anticholinergic drugs had poorer cognitive performance. Eight-five percent met the criteria for mild cognitive impairment, compared to 35 percent of people who had not taken the drugs.
"What we showed is that many of the people who are classified in this way have it due to the medication they are taking, and not because they have early Alzheimer's disease," Ritchie said.
Anticholinergic drugs are prescribed to relieve tremors, muscle stiffness, weakness, anxiety, incontinence and sleep problems. There are also drugs not listed in the same class that have anticholinergic properties.
"The cholinergic system consists of neurotransmitters that regulate a lot of our mental functioning, particularly related to memory," said Ritchie.
---- heres the actual article ----
bmj.bmjjournals.com/cgi/content/abstract/bmj.38740.439664.DEv1?rss=1
BMJ, doi:10.1136/bmj.38740.439664.DE (published 1 February 2006)
Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study
Marie L Ancelin 1, Sylvaine Artero 1, Florence Portet 1, Anne-Marie Dupuy 1, Jacques Touchon 1, Karen Ritchie 1*
1 Inserm, E361, Pathologies of the Nervous System, 34093 Montpellier, France
Objective - To assess the potential of anticholinergic drugs as a cause of non-degenerative mild cognitive impairment in elderly people.
Design - Longitudinal cohort study.
Setting - 63 randomly selected general practices in the Montpellier region of southern France.
Participants - 372 people aged >60 years without dementia at recruitment.
Main outcome measures - Anticholinergic burden from drug use, cognitive examination, and neurological assessment.
Results - 9.2% of subjects continuously used anticholinergic drugs during the year before cognitive assessment. Compared with non-users, they had poorer performance on reaction time, attention, delayed non-verbal memory, narrative recall, visuospatial construction, and language tasks but not on tasks of reasoning, immediate and delayed recall of wordlists, and implicit memory. Eighty per cent of the continuous users were classified as having mild cognitive impairment compared with 35% of non-users, and anticholinergic drug use was a strong predictor of mild cognitive impairment (odds ratio 5.12, P=0.001). No difference was found between users and non-users in risk of developing dementia at follow-up after eight years.
Conclusions - Elderly people taking anticholinergic drugs had significant deficits in cognitive functioning and were highly likely to be classified as mildly cognitively impaired, although not at increased risk for dementia. Doctors should assess current use of anticholinergic drugs in elderly people with mild cognitive impairment before considering administration of acetylcholinesterase inhibitors.
------------------
Norbert
Anticholinergic: What Does It Mean?
Anticholinergic effects are caused by drugs that block the action of acetylcholine. Acetylcholine is a neurotransmitter—a chemical messenger released by a nerve cell to transmit a nerve signal a neighboring nerve cell or a target cell in a muscle or gland. Acetylcholine stimulates smooth (involuntary) muscle cells, such as those in the heart or airways, to contract. Many commonly used drugs have anticholinergic effects. Most these drugs were not designed to produce these effects, which are therefore usually considered undesirable side effects. Anticholinergic effects include confusion, blurred vision, constipation, dry mouth, light-headedness, and difficulty with urination or loss of bladder control. However, anticholinergic drugs can also, for example, reduce tremors and nausea—both useful effects.
Older people are more likely to experience anticholinergic effects because the amount of acetylcholine in the body decreases with age. Consequently, anticholinergic drugs block a higher percentage of acetylcholine. Also, the aging body is less able to use what little acetylcholine is present.
---------------
My note-
People with alzheimers have an even lower level of acetylcholine, the neurotransmitter needed for thought. That is why Aricept is used in Alzheimers, to help retain the acetylcholine that is present. Drugs with anticholinergic properties will increase confusion and increase the tendency for psychotic thoughts (suspicions, delusions, and hallucinations.)
----------------------
from WebMD
Common Drugs May Raise Alzheimer's Risk
Finding in Parkinson's Patients Offers Hint of New Dementia Treatments
By Daniel DeNoon WebMD Medical News Archive
Reviewed By Brunilda Nazario, MD on Friday, July 25, 2003
July 25, 2003 -- Drugs often used by patients with Parkinson's disease may increase their risk of another killer brain disease: Alzheimer's.
The drugs -- called anticholinergic agents -- slow electrical impulses in nerve cells. They're used to help Parkinson's disease patients control unwanted movement such as tremors. These drugs also help with bladder control and dizziness. But other common drugs have anticholinergic activities, too. These include older allergy drugs and tricyclic antidepressants.
The report in the August issue of Annals of Neurology comes from Elaine K. Perry, PhD, senior scientist at University of Newcastle upon Tyne and colleagues. Perry's team examined the brains of deceased Parkinson's patients for the plaques and tangles seen in the brains of Alzheimer's patients.
The result: Those who took anticholinergic drugs for more than two years had significantly more plaque and tangles than those who never took the drugs. Taking the drugs for less than two years had no effect.
"What we saw were very, very low levels of Alzheimer's disease pathology, nothing like what you would see in Alzheimer's disease," Perry tells WebMD. "The drugs might increase this pathology, but they are not taking people into Alzheimer's disease."
But Allan Levey, MD, PhD, chair of the neurology department at Emory University School of Medicine, says these patients may have been on the way to Alzheimer's. Levey's commentary appears in the same issue of Annals of Neurology.
"If these people with Parkinson's disease had lived longer, they might have developed Alzheimer's disease," Levey tells WebMD.
Alzheimer's Risk in Widely Used Older Drugs
The category of drugs linked to Alzheimer's changes aren't now the front-line drugs for Parkinson's disease. One reason is that they can have terrible side effects. Medical students remember these side effects by learning a series of similes:
• "Mad as a hatter." Anticholinergic drugs can make patients delirious.
• "Blind as a bat." The drugs can dilate the pupils of the eye, making it hard to see.
• "Red as a beet." Flushing is a common side effect.
• "Dry as a bone." Dry skin is another side effect.
• "Hot as a hare." The drugs can cause overheating or hyperthermia.
Elderly patients are particularly likely to become confused when taking anticholinergic medicines. But the drugs are still widely used. And sometimes doctors aren't aware that other drugs their patients are taking have the same effects.
"The uglier perspective is all the drugs that have anticholinergic side effects," Levey says. "These are a lot of common medicines like antihistamines and the older antidepressants. And also we are talking about a worldwide problem, where many poorer nations don't have access to the more expensive new antidepressants."
Levey says the new findings don't prove anything. But they add another reason to prescribe these drugs with caution.
Perry also warns against jumping to conclusions.
"We cannot make any change to clinical practice based on one study," she says. "We need more studies before we can say, 'Be cautious about these drugs.' It is not right to start a panic in people taking these medicines."
But Levey says it can't hurt to talk this over with your doctor.
"Talk to your doctor about avoiding medicine with anticholinergic properties," he advises. "That's more because of the immediate effects, not because of new concerns about Alzheimer's disease. And if you need the medicines, don't worry about this."
Silver Lining: A Window on New Alzheimer's Treatments
There are also drugs that have the opposite effect of anticholinergic drugs. These compounds speed electrical impulses in nerve cells. Animal studies show that they can reduce plaques and tangles in the brain.
SOURCES: Annals of Neurology, August 2003. Elaine K. Perry, PhD, senior scientist, University of Newcastle upon Tyne, U.K. Allan Levey, MD, PhD, chair, department of neurology, Emory University School of Medicine, Atlanta.
---------------
And this article regarding Benadryl
“Anti Antihistamine” From AARP Bulletin, Oct 2004 pg12
Diphenhydramine is “best known under it’s brand name Benadry, is in a myriad of other over-the-counter medications including Exedrin PM, Nytol, Sleep-eve, sominex, Tylenol PM, and Unisom, to name just a handful.
For People age 60 and older, however, diphenhydramine is mostly bad news because it’s adverse effects are amplified in older people. A study in 2001 in the Archives of Internal Medicine found that a group of hospitalized patients 70 and older who were given the drug “had significantly increased risk of altered attention level, disorganized speech, change in consciousness and alertness, and behavioral disturbances,” according to lead author, Joseph Agostini, a professor at Yale University School of Medicine.
In the worse case, diphenhydramine can cause delirium and Hallucinations. What’s more, it often causes urinary retention, which can lead to urinary infections.
Geriatric specialists say the drug is not recommended for older patients.
Among other potential adverse effects of diphenhydramine are: dizziness or hypotinsion (low blood pressure), which dramatically increase the risk of falls; drowsiness; bowel problems (decreased motility), difficult or painful urination, dryness of mouth, nose or throat. Also: nervousness, restlessness, irritability and unusual excitement or nightmares.
Agnostini’s Assessmenti fo the drug as a sleep medication for an older person is blunt: “This is a horrible choice – I almost can’t think of anything worse.”
-----------------
My note - because of decreased levels of Acetycholine in people with Alzheimers and Lewy body, the effects of anti-cholinergic drugs on confusion and psychosis is even greater.
ANTICHOLINERGIC DRUGS
Tylenol PM (contains benadryl)
Anti-cholinergics (bladder control) Deltrol
Antispasmodics
antihistamines
Muscle relaxants (most)
narcotic pain relievers – codine, Oxycodone
Tricyclic antidepressants - Amitriptyline(Elavil, Endep, etc)
benzodiazepines for anxiety - Xanax, Valium, Ativan
Benzodiazepines for sleep (Barbituates)
conventional antipsychotics - Haldol
high doses of "mydriatic" class eye drops.
further References –
“Beer’s Criteria for Potentially Inappropriate Medication Use in the Elderly” by Sheila Molony - from the Try This series.
www.hartfordign.org/publications/trythis/issue16.pdf
The Merck Manual of Geriatrics, Chapter 6 Clinical Pharmacology,
www.merck.com/mrkshared/mm_geriatrics/sec1/ch6.jsp
Table 6-4 High Risk Drugs in the Elderly
www.merck.com/mrkshared/mm_geriatrics/tables/6t4.jsp
------------------
here's another article on this
From Yahoo health
au.health.yahoo.com/060201/3/ieqm.html
Drug side effects can mimic early dementia: study
LONDON (Reuters) - Common drugs used to treat depression, Parkinson's disease and allergies can produce side effects that can be mistaken for early dementia, scientists said on Wednesday.
They added that doctors should be aware the drugs, known as anticholinergics, can cause confusion, memory loss and disorientation and question patients about medication they are taking before prescribing drugs for early dementia.
"A large number of elderly people are taking medications that can mimic early dementia and are likely to be classed as having early dementia," said Karen Ritchie, of the Hopital La Colombiere in Montpellier, France.
There is no cure for Alzheimer's disease, the leading cause of dementia in the elderly. The main treatments for early dementia are pro-cholinergic drugs.
"We might find a large number of people in the rather ridiculous position of taking what we call pro-cholinergic medication to counteract anticholinergic drugs they are already taking," Ritchie said in an interview.
"A very large number of people with so-called early dementia have these effects due to drug consumption. The drugs they are taking are very common -- they include things like antihistamines," she added.
The researchers, whose findings are published online by the British Medical Journal, questioned 372 elderly people without dementia about the drugs they had taken and their past illnesses. Ten percent had used anticholinergic drugs for a long period.
After monitoring and assessing the patients for up to 8 years, the researchers found that people who had used anticholinergic drugs had poorer cognitive performance. Eight-five percent met the criteria for mild cognitive impairment, compared to 35 percent of people who had not taken the drugs.
"What we showed is that many of the people who are classified in this way have it due to the medication they are taking, and not because they have early Alzheimer's disease," Ritchie said.
Anticholinergic drugs are prescribed to relieve tremors, muscle stiffness, weakness, anxiety, incontinence and sleep problems. There are also drugs not listed in the same class that have anticholinergic properties.
"The cholinergic system consists of neurotransmitters that regulate a lot of our mental functioning, particularly related to memory," said Ritchie.
---- heres the actual article ----
bmj.bmjjournals.com/cgi/content/abstract/bmj.38740.439664.DEv1?rss=1
BMJ, doi:10.1136/bmj.38740.439664.DE (published 1 February 2006)
Non-degenerative mild cognitive impairment in elderly people and use of anticholinergic drugs: longitudinal cohort study
Marie L Ancelin 1, Sylvaine Artero 1, Florence Portet 1, Anne-Marie Dupuy 1, Jacques Touchon 1, Karen Ritchie 1*
1 Inserm, E361, Pathologies of the Nervous System, 34093 Montpellier, France
Objective - To assess the potential of anticholinergic drugs as a cause of non-degenerative mild cognitive impairment in elderly people.
Design - Longitudinal cohort study.
Setting - 63 randomly selected general practices in the Montpellier region of southern France.
Participants - 372 people aged >60 years without dementia at recruitment.
Main outcome measures - Anticholinergic burden from drug use, cognitive examination, and neurological assessment.
Results - 9.2% of subjects continuously used anticholinergic drugs during the year before cognitive assessment. Compared with non-users, they had poorer performance on reaction time, attention, delayed non-verbal memory, narrative recall, visuospatial construction, and language tasks but not on tasks of reasoning, immediate and delayed recall of wordlists, and implicit memory. Eighty per cent of the continuous users were classified as having mild cognitive impairment compared with 35% of non-users, and anticholinergic drug use was a strong predictor of mild cognitive impairment (odds ratio 5.12, P=0.001). No difference was found between users and non-users in risk of developing dementia at follow-up after eight years.
Conclusions - Elderly people taking anticholinergic drugs had significant deficits in cognitive functioning and were highly likely to be classified as mildly cognitively impaired, although not at increased risk for dementia. Doctors should assess current use of anticholinergic drugs in elderly people with mild cognitive impairment before considering administration of acetylcholinesterase inhibitors.
------------------
Norbert