Data Collection And Analysis
Data was abstracted independently by two authors. Differences were settled by discussion among all authors. Data collected included patient characteristics, disease duration and severity, concomitant medication, interventions including duration and dose of anticholinergic treatment, outcome measures, rates of and reasons for withdrawals, and neuropsychiatric and cognitive adverse events.
Data Sources And Study Patients
We used the 2017 Health Insurance Review and Assessment ServiceAged Patient Sample data , a national representative data comprising a random sample of 10% of elderly Korean patients each year. The patient samples were extracted using a stratified random sampling method from the claims data of the Korean National Health Insurance . this data is collected when healthcare providers submit a claim to HIRA for reimbursement for a service provided to patients . HIRA-APS data include information on the sociodemographic characteristics of patients such as age, sex, and type of the National Health Security program in which the patient has enrolled . Moreover, in includes diagnosis and procedure codes for the NHS-covered inpatient and outpatient services provided to patients, prescription drugs, and selected characteristics of healthcare providers . The research protocol was approved by the Institutional Review Board of Yonsei University, Seoul, South Korea . The informed consent requirement from the study population was waived by the board on account of the retrospective nature of the study. All methods were performed in accordance with the declaration of Helsinki.
PD patients with dementia, who can be also referred to as dementia patients with PD, were defined as patients having at least one claims record with a diagnosis of PD code: G20 or G21 ) and at least one claims record with a diagnosis of dementia in 2017.
What’s Hot In Pd Short And Long
People with Parkinson’s disease frequently struggle to identify drug therapies that can address bothersome symptoms such as sleep dysfunction, bladder urgency, drooling and tremor. Many of the drug therapies such as Benadryl , Advil PM, Alleve PM, common antihistamines, and others pills are readily available over the counter and do not require a prescription. These medications block a cholinergic receptor in the brain, and can improve many Parkinsons disease symptoms. However, the price of taking these drugs may be steep . An older French study of hospitalized Parkinsons disease patients revealed that though 46% of all demented patients were confused, 93% on anticholinergic therapy had delirium and confusion when in the hospital . Deficiencies of the chemical acetylcholine have been reported to underpin thinking issues and shortages of the chemical have been observed in the brainstem, hippocampus, and cortex of Parkinsons disease patients. Though anticholinergic use can result in drowsiness, dry mouth, urinary retention, memory problems as well as constipation, many patients find these therapies useful. In this months Whats Hot column we will address the short and long-term potential side effects of using of anticholinergic medications in Parkinsons disease.
Some practical suggestions include:
Selected References:
Sakakibara R. . Rinsho Shinkeigaku. 2013 53:1389-92. Review. Japanese. PubMed PMID: 24292000.
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Anticholinergics In Clinical Trials For Parkinsons Disease
Several studies have shown that anticholinergics are useful in reducing tremors. Two studies, one published in Movement Disorders and the other in Archives of Neurology, found that anticholinergics, as well as dopamine agonists , are effective at reducing tremors in Parkinsons disease. Some patients responded better to one treatment than the other.
Studies have also shown, however, that anticholinergics may be associated with greater cognitive decline in Parkinsons patients. A meta-analysis study showed that anticholinergics lead to a definite improvement in motor symptoms but are also associated with side effects including cognitive decline and hallucinations. The study analyzed six anticholinergics but did not have enough evidence to compare their efficacy.
How Do Anticholinergics Work
The motor symptoms of PD are caused by the reduction in dopamine. This is a neurotransmitter that sends signals in the brain to produce smooth, purposeful movement. As PD damages and destroys the nerve cells that make dopamine, the motor symptoms of PD appear.1,2
The primary treatments for PD directly affect dopamine. However, anticholinergics work in a different way to treat the symptoms of PD. They block the action of acetylcholine. This is another neurotransmitter involved in messages from the brain to the muscles. Anticholinergics work on correcting an imbalance between acetylcholine and dopamine in an area of the brain. Anticholinergics are often used in along with other treatments for PD.1,2
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What Is An Anticholinergic
Anticholinergics are a type of medication that blocks the action of a neurotransmitter called acetylcholine. Acetylcholine transfers signals between cells that affect specific bodily functions.
The medication blocks acetylcholine from causing involuntary muscle movements in the lungs, gastrointestinal tract, urinary tract, and other areas of the body.
As anticholinergics can affect a variety of functions, including digestion, urination, salivation, and movement, they can help treat many conditions.
Anticholinergic drugs work by blocking the activity of acetylcholine, a neurotransmitter, in the cholinergic system. The cholinergic system plays a role in:
Avoid Anticholinergics In Parkinsons Say Researchers Despite Study Findings
Researchers say there are good reasons why study did not confirm deleterious effects on cognition in Parkinsons disease patients.
Adverse drug events
BSIP, Cavalini James / Science Photo Library
Use of anticholinergic drugs by patients with newly diagnosed Parkinsons disease is not associated with cognitive decline, according to new research, but the study authors say there may be good reasons why these findings contradict previous studies.
The study, led by Alison Yarnall, a research fellow at Newcastle University, used data from the ICICLE-PD study a twin-centre, longitudinal, observational study exploring the development of dementia in Parkinsons disease .
The researchers studied the medication history of 219 patients with incident PD and 99 healthy controls to calculate each participants anticholinergic burden using the anticholinergic drug scale . Each drug was given a score from 0 to 3 according to its level of anticholinergic activity and these were summed at baseline and 18 months for each participant.
Comparing patients who had an ADS score of 0 at 18 months with those with an ADS score of one or more at both time points , the researchers found no difference in global cognition or in assessments of attention, memory or executive function. The proportion of patients with mild cognitive impairment was also similar between the two groups, at 49.4% in PD+ADS and 45.5% in PD-ADS .
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Is Parkinsons Disease Treated By A Neurologist
People with Parkinsons disease will usually require a team of healthcare professionals to help them manage the condition.
A neurologist, a doctor specializing in conditions of the brain and nervous system, will be one of the main people involved in treating Parkinsons.
Other healthcare professionals who may help treat Parkinsons can include:
- a persons regular doctor
- a physical therapist
- a speech or occupational therapist
- mental health professional
- other specialists, such as a gastroenterologist, if people experience other symptoms of Parkinsons such as digestive issues
What Are Anticholinergic Antiparkinson Agents
Anticholinergic antiparkinson agents or acetylcholine antagonists block the muscarinic acetylcholine receptors and cholinergic nerve activity. Activation of muscarinic receptors has an excitatory effect, opposite to that of dopaminergic activation, so suppression of the effects of acetylcholine compensates for a lack of dopamine in Parkinson’s disease. Acetylcholine and dopamine have to be carefully balanced for proper body movement. Anticholinergic agents create a better balance between acetylcholine and dopamine. Anticholinergic agents are used to treat patients with Parkinson’s disease who have tremor.
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How Do Anticholinergic Antiparkinson Agents Work
Anticholinergic antiparkinson agents are a class of medications used to treat the symptoms of Parkinsons disease.
The direct cause of Parkinson’s disease or Parkinsonian-like syndrome is the deficiency of the neurotransmitterdopaminein the brain. Antiparkinson medicines aim to prolong the action of dopamine in the brain by:
- Replacing dopamine
- Inhibiting dopamine breakdown
- Sensitizing dopamine receptors to stimulate dopamine release
Anticholinergic antiparkinson agents prolong dopamine action in the brain by inhibiting the reabsorption and storage of neurotransmitters. Reabsorption is a normal mechanism by which the body controls how long a nerve signal lasts. However, reabsorption can be an issue when there is a low level of dopamine. Hence, by limiting the reuptake of dopamine, anticholinergics increase dopamine concentration in the brain.
What You Should Know About Your Parkinson’s Medication
Each medication has its own particular properties and important considerations to be aware of. Below are some key aspects to think about before you start taking your medication. Detailed information regarding these can be found in the Patient Information Leaflet :
- what is it and what is it used for?
- special warnings and precautions
- contraindications
- interaction with other medication
- what to do if you forget to take a dose
- what to do if you take more than you should
- possible effects on your ability to drive or use machinery
- safety in pregnancy and breast-feeding
The active ingredient in Disipal® Tablets belongs to the group of medicines called anticholinergic agents. Disipal® Tablets are used in the treatment of all forms of Parkinsons, a condition which can cause uncontrollable trembling of the hands, and other difficulties of movement, for example in standing or walking. Anticholinergic agents are also used when other medicines have caused these problems.
Procyclidine belongs to a group of medicines called anticholinergics. Anticholinergics stop a substance called acetylcholine working in your body.
Procyclidine is predominantly used in Parkinsons to help with muscle control and reducing stiffness.
Patient Information Leaflet and Summary of Product Characteristics
The PIL is the leaflet that is included with a medicine and is a patient-friendly version of the Summary of Product Characteristics. It gives information about taking or using a medicine.
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What Are The Possible Side Effects Of Anticholinergics
Side effects can vary depending on the specific drug you are taking. The most common side effects of anticholinergic drugs include:3
- Memory problems
These are not all the possible side effects of anticholinergics. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with anticholinergics.
Types Of Anticholinergics Used In Parkinsons Disease
Anticholinergics were the first form of treatment for Parkinsons disease and have been used to treat Parkinsons-related tremors and dystonia for a long time. The earliest reports of anticholinergic medications for Parkinsons are from the 19th century. Many anticholinergic medications have been developed, with a wide assortment marketed in the mid-20th century.
The two most commonly prescribed anticholinergics are Cogentin and Artane , both available as generics.
Other anticholinergics include Norflex , also available as a generic, and profenamine, available in Canada. Kemadrin is no longer available in the U.S. but is available in Europe and as a generic in Canada.
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Anticholinergic Load: Is There A Cognitive Cost In Early Parkinsons Disease
Article type: Short Communication
Authors: Yarnall, Alison J.a * 1 | Lawson, Rachael A.a 1 | Duncan, Gordon W.a | Breen, David P.b | Khoo, Tien K.a 2 | Brooks, Davidc | Barker, Roger A.b | Taylor, John-Paula | Burn, David J.a
Affiliations: Institute of Neuroscience, Newcastle University, UK | John van Geest Centre for Brain Repair, University of Cambridge, UK | PET Center, Aarkhus University, Denmark
Correspondence: Correspondence to: Dr Alison Yarnall, Institute of Neuroscience, Clinical Ageing Research Unit, Newcastle University, Newcastle upon Tyne NE4 5PL, UK. Tel.: +44 191 208 1279 Fax: +44 191 208 1250 E-mail:
Note: These authors contributed equally.
Note: The author has sincemoved and his permanent address is Schoolof Medicine, Griffith University, Gold Coast, Australia.
Abstract: We evaluated the effect of anticholinergic burden on 219 participants with incident Parkinsons disease and 99 controls at study baseline and 18 months. Anticholinergic burden for each individual was calculated and summed according to the Anticholinergic Drug Scale . Medication with anticholinergic activity was more commonly prescribed in PD compared to controls, although mean ADS scores were not significantly different. Cognitive scores did not differ in PD participants taking medications with anticholinergic activity compared to those who were not. Low overall ADS scores due to increased awareness of adverse effects of medications and brevity of follow-up are potential explanations.
Anticholinergic Drugs Can Improve Movement Symptoms Of Parkinsons Disease But With Adverse Mental Effects And There Is Not Enough Evidence To Compare The Different Drugs
Anticholinergics were the first drugs available for Parkinson´s disease and they are still widely used. They are believed to work by counteracting an imbalance which exists in Parkinson´s disease between two chemicals in the brain which transmit messages between nerve cells. However, anticholinergic drugs have been associated with unfavourable side effects. They are used alone, or with other anti-Parkinsons drugs. The review of trials found that anticholinergics can improve movement problems in people with Parkinsons disease, but also cause adverse mental effects . There is not enough evidence to compare the different anticholinergic drugs.
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Enhancing Healthcare Team Outcomes
Anticholinergic medications are quite prevalent throughout the healthcare system, and many drugs that are not used explicitly for their anticholinergic properties still have anticholinergic side effects. The entire interprofessional healthcare team, including all clinicians , nurses, and pharmacists, need to be well-versed in both the therapeutic and adverse properties of anticholinergic drugs. This is most important regarding the contribution of anticholinergics to adverse events. The team should monitor the overall anticholinergic burden, attempt to limit unnecessary use of anticholinergic medications, and pay special attention to high-risk groups such as the elderly and those receiving treatment for depression and schizophrenia.
How Anticholinergics Work
In the brain, there is normally a balance between two neurotransmitters: acetylcholine and dopamine. In Parkinsons disease, the death of dopamine-producing nerve cells throws off the balance between these two neurotransmitters, causing many of the diseases symptoms. Anticholinergics work by blocking the acetylcholine receptors on nerve cells without activating them. This helps reduce the effect of acetylcholine and balance the effect of decreased amounts of dopamine.
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What Are Anticholinergics
Anticholinergics are a class of drugs used to treat a wide range of medical conditions, from asthma to the side effects of certain psychiatric medications. They are also used to treat some symptoms of Parkinsons disease.
They can help to decrease the involuntary movement of muscles in your body that are part of the disease. For instance, with Parkinsons disease, anticholinergics are used to control tremors that are commonly characteristic of the condition.
What Else Is There
Selegiline and the catechol-o-methyl transferase inhibitor, entacapone are both useful in treating early end of dose deterioration in l-dopa treated patients. Both drugs are well tolerated and may also possibly have useful effects on drive, motivation, and depression, but further work is needed to confirm this in clinical trials. Entacapone is only useful in combination with l-dopa 200 mg should be given with each l-dopa dose. In contrast, selegiline has weak, mild symptomatic effects and may be considered as an initial treatment in mildly disabled patients. The new buccal formulation of selegiline does not produce significant quantities of amphetamine catabolites, but it remains unclear whether this confers safety or efficacy benefits over standard selegiline.
Controlled release formulations of l-dopa are still in vogue for treating nocturnal disability, but there is no evidence they are clearly superior in this regard to standard l-dopa. Dispersible formulations of l-dopa may be useful for delayed morning start up time, usually working after 2030 minutes compared with 3060 minutes for standard l-dopa. Dopamine agonist drugs are extremely useful and important l-dopa sparing agents, reducing motor complications and benefiting off period disabilities. There is very little to choose between them in efficacy, and it is likely that most of the reported adverse events are class effects.
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