Caution: holinolytics!
Indiana University researchers recommend that elderly people avoid taking drugs of the class of cholinolytics (anticholinergetics) if possible because of the associated increased risk of cognitive impairment.
Drugs with cholinolytic effects, that is, the ability to block the activity of the neurotransmitter acetylcholine, are available without a prescription and are often prescribed to improve sleep and in the treatment of many chronic diseases, including hypertension, diseases of the cardiovascular system and chronic obstructive pulmonary disease.
Earlier studies have demonstrated the existence of an association between taking these drugs and an increased risk of cognitive impairment, as well as dementia in the elderly. In particular, in 2013, scientists from the Center for the Study of Aging at Indiana University and the Regenstrif Institute found that cognitive problems in older people can occur after 60 days of continuous intake of strong anticholinergic drugs. Weaker drugs require 90 days to do this.
The authors decided to understand the biological mechanisms underlying this phenomenon. To do this, they used data collected in the framework of three major studies devoted to the study of Alzheimer's disease and other age-related cognitive disorders: Alzheimer's research project, The Alzheimer's Disease Neuroimaging Initiative and the Indiana Memory and Aging Study.
A total of 451 participants (median age 73.3 years) were included in the study, of which 60 participants took at least 1 drug with medium or high anticholinergic activity. To assess possible physical and physiological changes potentially associated with the registered effects of drugs, the authors analyzed the results of memory tests and other cognitive tests, as well as the results of positron emission tomography used to assess the level of brain metabolism, and magnetic resonance imaging used to visualize the structure of the brain.
Analysis of the results of cognitive function testing showed that patients taking anticholinergic drugs performed worse on tasks for short-term memory and the ability to purposeful activity than elderly people who did not take drugs of this class. These tests cover a range of activity, including verbal thinking, planning ability and problem solving.
Patients taking anticholinergic drugs were also characterized by lower levels of glucose metabolism, which is a biomarker of brain activity, both in the brain as a whole and in the hippocampus, a region of the brain associated with memory and, as a rule, suffering already at the early stages of Alzheimer's disease.
There was also a pronounced relationship between taking anticholinergic drugs and changes in the structure of the brain, such as a decrease in the volume of nervous tissue, ventricular expansion and the appearance of cavities in brain tissue, visible on the images obtained using magnetic resonance imaging.
According to the authors, the data obtained shed light on the biological basis of cognitive disorders associated with taking anticholinergic drugs, however, further research is needed to identify the mechanisms involved. At the same time, they recommend that attending physicians refuse to prescribe cholinolytics to elderly patients in the presence of alternative medicines.
A list of anticholinergic drugs and their potential effects can be found on the radar site (in Russian, but very difficult) or here (a simple table, but in English).
Article by Shannon L. Risacher et al. The Association Between Anticholinergic Medicine Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults is published in the journal JAMA Neurology.
Evgeniya Ryabtseva
Portal "Eternal youth" http://vechnayamolodost.ru
based on materials from Indiana University School of Medicine: IU scientists: Brain scans link physical changes to cognitive risks of widely used class of drugs.
28.04.2016