Brief Report
Serum Anticholinergic Activity and Cognition in Patients With Moderate-to-Severe Dementia

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Objective

The authors investigated the association between serum anticholinergic activity (SAA) and cognitive performance in a group of patients with moderate-to-severe dementia.

Methods

SAA and cognitive performance were assessed in 26 patients admitted to a geropsychiatric unit for the treatment of behavioral disturbances associated with dementia. SAA was measured by radioreceptor competitive binding assay. Cognition was tested with the Mini-Mental State Exam and the Severe Impairment Battery.

Results

Higher SAA was associated with lower cognitive performance.

Conclusions

This study extends to patients with moderate-to-severe dementia the finding that higher SAA is associated with lower cognitive performance.

Section snippets

METHODS

All subjects in this report participated in an ongoing, federally-funded clinical trial (“Continuation Pharmacotherapy for Agitation of Dementia,” [MH 59666]) for the treatment of behavioral disturbances or psychosis associated with dementia. Between February 2000 and April 2002, all patients admitted to Western Psychiatric Institute and Clinic's geriatric inpatient unit were considered for inclusion if they presented with behavioral disturbances or psychosis associated with dementia of the

RESULTS

The subjects' mean (standard deviation [SD]) age was 83.6 (5.8) years; 12 (46%) were women; 22 (85%) and 4 (15%) had an admission diagnosis of dementia of the Alzheimer type and dementia NOS, respectively. The mean number of prescription medications was 6.2 (3.5); 6 subjects (23%) were taking a cholinesterase inhibitor; 15 subjects (58%) had received a prn dose of lorazepam within 24 hours of SAA blood-draw or cognitive assessments.

SAA was detectable in 16 (62%) of the 26 subjects; the mean SAA

DISCUSSION

We found an association between serum anticholinergic activity (SAA) and cognitive performance in a group of patients with moderate-to-severe dementia. Our results extend the findings from 13 previous studies conducted in older adults (see Table 1), mostly in patients with no or mild dementia. Taken together, these data support the thesis that medications having anticholinergic properties should be avoided in patients with dementia. This includes not only medications classified as

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Cited by (0)

The authors thank Kimberly Huber, B.A., and Nicole Wilson, B.S., for collecting the data, B. Richard Cumbie for his technical assistance, and Amy E. Begley, M.A., for assistance with data analysis.

This work was supported in part by US PHS grants MH59666, MH52247, MH30915, MH01613, MH01509, MH65416, AG05133, and RR00056, from the National Institute of Health, and a 2003 Glenn-AFAR Scholarship from the American Federation for Aging Research. The CPAD Study Group: Margaret A. Kirshner, B.A.; N.J. Jacob, M.D.; Kari B. Kastango, M.S.; Robert S. Marin, M.D.; Jules Rosen, M.D.; Robert A. Sweet, M.D.; and Channamalappa Umapathy, M.D.

Dr. Pollock has grant/research support from the National Institute of Mental Health, Janssen Pharmaceutica, Forest Pharmaceuticals, Inc., and GlaxoSmithKline. He is also a consultant to Forest Pharmaceuticals, Inc., Janssen Pharmaceutica, Organon Pharmaceuticals USA, Inc., GlaxoSmithKline, AstraZeneca, Alexza Molecular Delivery Corp., Warner Chilcott, Novartis, and Sepracor, and on the speakers' bureau at Forest Pharmaceuticals and GlaxoSmithKline. Dr. Mulsant has received grants/research support from NIH, Janssen, AstraZeneca, Corcept, and Forest; and he has been involved with the speaker's bureau for AstraZeneca, Forest, GlaxoSmithKline, Janssen, and Pfizer/Esai.

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