The treatment of Alzheimer’s disease (AD) relies heavily on cholinesterase inhibitors, which help salvage acetyl-choline and maintain function in the cho-linergic system. However, these agents are expensive and affect cognition only slightly. Patients with AD are sensitive to cognitive impairments induced by anti-cholinergic drugs.
Avoidance of anticholinergic agents should be the rule for patients with AD, the researchers say, because of the “exquisite sensitivity” of these patients to the cognitive and other psychiatric adverse effects associated with these agents, whether or not they are receiving a cholinesterase inhibitor.
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If a patient is already receiving the drugs in combination, the researchers advise stopping the anticholinergic medication or choosing a “less” anticholin-ergic drug. They also advise substituting cautiously, because an anticholinergic withdrawal syndrome can cause seizures if the drug is stopped too abruptly.