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anticholinergics can cause symptoms of dementia

Unax Lertxundi, Arantxazu Isla, Maria Angeles Solinis, Saioa Domingo-Echaburu, Rafael Hernandez, Javier Peral-Aguirregoitia, Juan Medrano
PURPOSE: Anticholinergic toxicity can arise as a result of the cumulative burden of multiple medications and metabolites rather than be caused by a single compound. In this sense, prescribing drugs with anticholinergic properties to Parkinson's disease (PD) patients could contribute to aggravate some frequent problems of the disease, like dementia, urinary retention, falls, or constipation, among others. The main purpose of this article is to measure the total anticholinergic burden in a group of PD inpatients...
October 2015: European Journal of Clinical Pharmacology
Delia Bishara, Daniel Harwood
OBJECTIVE: The prescription of multiple medications for older people is common, despite concerns over the dangers associated with this. Older adults are particularly vulnerable to adverse effects of medication, and this is an even greater risk in patients with dementia. Many drugs used for physical health conditions can negatively affect cognition. Our aim was to identify areas of concern and which drugs to avoid in patients with dementia. DESIGN: A review of the literature was carried out using Pubmed, Medline and Embase...
December 2014: International Journal of Geriatric Psychiatry
Lutz M Drach
Delirium is frequent in hospitalized elderly. Treatment of the medical problems causing delirium is paramount. Mostly antipsychotics are used for treatment of psychological and behavioral symptoms in delirium. Increased mortality of elderly and demented patients receiving antipsychotics suggests caution in prescribing antipsychotics for delirium. Standard treatment is low-dose haloperidol. If more sedation is needed, melperone or pipamperone can be used. In delirious Parkinsonian patients or if dementia with Lewy-bodies is suspected quetiapine is better tolerated...
April 2014: Medizinische Monatsschrift Für Pharmazeuten
Lutz M Drach
Dementia with Lewy-bodies (DLB) and Parkinson's disease dementia (PDD) are no rare causes of dementia. Both have neuropathologically, clinically, and neurochemically much in common. In the course of both conditions frequently psychotic symptoms occur, often induced by antiparkinsonian medication. Treatment of psychotic features with conventional antipsychotics is not tolerated in many cases. Therefore low-dose clozapine treatment is acknowledged usual practise for psychosis in Parkinson's disease and a case report indicates efficacy for psychosis in DLB, too...
February 2011: Medizinische Monatsschrift Für Pharmazeuten
Christine J Lim, Christina Trevino, Rajesh R Tampi
OBJECTIVE: To report a case of delirium probably caused by the atypical antipsychotic olanzapine in a 74-year-old man with dementia. CASE SUMMARY: A 74-year-old white man with a diagnosis of severe dementia of mixed etiology with behavioral disturbances was admitted to an urban teaching hospital for increasing agitation in the context of worsening dementia. Olanzapine 2.5 mg each evening was started for agitation, and the dose was titrated to 5 mg each evening with additional emergent doses...
January 2006: Annals of Pharmacotherapy
Rita Moretti, Paola Torre, Rodolfo M Antonello, Tatiana Cattaruzza, Giuseppe Cazzato
Behavioral problems produce excess disability, potentially devastating in cognitively impaired patients. These behavioral symptoms can be a major cause of stress, anxiety and concern for caregivers. While psychotropic drugs are frequently used to control these symptoms, they have the potential for significant side effects, which include sedation, disinhibition, depression, falls, incontinence, parkinsonism and akathisia. We followed up (for 12 months) a group of 346 consecutive outpatients, with a diagnosis of subcortical vascular dementia or multi-infarctual dementia...
October 2005: Journal of Neurology
Andrius Baskys
Lewy body dementia, also referred to as dementia with Lewy bodies (DLB), is a neurodegenerative disorder now considered to be the second most common cause of dementia after Alzheimer's disease. Postmortem findings suggest that DLB accounts for 20% to 34% of all dementia cases and is often underdiagnosed. Salient features of DLB include fluctuations in cognition, perceptual abnormalities (e.g., visual hallucinations), and mild parkinsonism. Other symptoms include frequent falls, nighttime agitation, and depression...
2004: Journal of Clinical Psychiatry
J F Ampélas, M J Wattiaux, A P Van Amerongen
UNLABELLED: We present one case of Sjögren's syndrome (SS) secondary to systemic lupus erythematosus (SLE) with predominant psychiatric manifestations, treated with success by cyclophosphamide. From this case, we review the psychiatric aspects of these two autoimmune diseases as described in the literature and we present the etiopathogenic hypothesis and treatment of the psychiatric disorders. Case report--In August 1996, a 38 year old man was admitted in our psychiatric department for agitation...
November 2001: L'Encéphale
M Zaudig
The importance of behavioural and psychological symptoms in dementia (BPSD) is increasingly being recognised. Symptoms such as verbal and physical aggression, agitation, sleep disturbances and wandering are common, cause great distress to caregivers and are likely to lead to institutionalisation of patients. At present, these symptoms are also more amenable to treatment compared with the progressive intellectual decline caused by dementing illnesses. The care of individuals with BPSD involves a broad range of psychosocial treatments for the patient and his or her family...
September 2000: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
S L Gray, K V Lai, E B Larson
The aetiology of cognitive impairment is multifactorial; however, drugs are an important cause of delirium and dementia. Several factors may increase the risk of drug-induced cognition disorders in the elderly including imbalances in neurotransmitters (e.g. acetylcholine), age-related alterations in pharmacokinetics and pharmacodynamics, and high levels of medication use. Nearly any drug can cause cognitive impairment in susceptible individuals; however, certain classes are more commonly implicated. Benzodiazepines, opioids, anticholinergics, and tricyclic antidepressants are probably the worst offenders...
August 1999: Drug Safety: An International Journal of Medical Toxicology and Drug Experience
F Valldeoriola, F A Nobbe, E Tolosa
Behavioural disorders in Parkinson's disease can grossly be subdivided in primary disturbances and those which are related to drug treatment. Depression and anxiety are a common feature in parkinsonian patients. Both occur independently of drug treatment. In general, most current antidepressive and anxiolytic drugs could be administered in Parkinson's disease with the same precautions as in the normal population. However, in single case reports modern serotonin reuptake blockers in Parkinson's disease have been accused to worsen parkinsonian motor condition...
1997: Journal of Neural Transmission. Supplementum
S I Finkel
As the world's population ages, increasing numbers of patients with dementia can be expected, the signs and symptoms of which can be extremely disruptive. In particular, behavioral and psychological signs and symptoms of dementia reduce the quality of life of carers (usually family members) and increase the cost of care. Conventional neuroleptics have been used for many years in the management of disturbed and disruptive demented patients, although there are few well-controlled clinical trials demonstrating their efficacy...
September 1997: International Clinical Psychopharmacology
C A Class, L Schneider, M R Farlow
Behavioural disorders occur with great frequency in patients with dementia. They are the major reason for admission of these patients to nursing homes. However, there have been few controlled trials of many of the commonly used drugs to guide therapy. To treat these conditions successfully, an adequate description of target symptoms of the behaviours to be corrected and a thorough investigation to identify precipitating causes are essential. Behavioural problems in dementia patients may results from physical illnesses, adverse drug effects, environmental changes, psychiatric syndromes (i...
February 1997: Drugs & Aging
I Karlsson
Non-cognitive symptoms are common in dementia. Emotional disturbances such as depression, anxiety and irritability-aggressiveness dominate. Depression is seen in about one third of demented persons. There are findings indicating that degenerative changes in the brain can cause depressive changes. Depression in elderly and in dementia differs from that in younger ages but no diagnostic criteria have yet been evaluated. Anxiety is a common symptom in depression suggesting a depressive-anxiety disorder. Specific serotonin re-uptake inhibitors (SSRI) are efficient in the treatment of both depression and anxiety while tricyclic antidepressants have side effects including cognitive reduction...
1996: Acta Neurologica Scandinavica. Supplementum
I Karlsson
Cognitive deterioration in dementia includes many changes besides memory disturbances, including agitation, delusions, hallucinations, anxiety, irritability, and aggressiveness. Antipsychotic drugs are often used to control behavioral symptoms, but their benefits are limited. Depression, which is common in dementia, is often associated with anxiety. Selective serotonin reuptake inhibitors (SSRIs) improve mood and reduce anxiety while causing few side effects; they are also useful in managing irritability. Thus, the SSRIs should be considered the agents of choice for treating noncognitive symptoms associated with dementia...
1996: Acta Neurologica Scandinavica. Supplementum
E Schneider, P A Fischer, P Jacobi, A Grotz
Exogenous psychotic symptoms of a wide variety have been reported to appear more and more frequently since the introduction of levodopa in the therapy of Parkinson's disease. They were considered to be caused by treatment related imbalance of cerebral neurotransmitters and hypersensitivity of the dopaminergic receptors, respectively. In the present investigation an analysis was done concerning the relevance of different antiparkinsonian drugs and other factors such as severity of neurological and cerebroorganic symptomatology, age, duration of treatment, EEG and brain atrophic changes and additional physical diseases for the appearance of psychotic symptoms...
June 1984: Fortschritte der Neurologie-Psychiatrie
M A Jenike
Affective illness is common, frequently debilitating, and sometimes life-threatening in the elderly. Considerations pertaining to treatment with heterocyclic drugs, MAOIs, lithium, psychostimulants and thyroid hormone, as well as ECT, have been reviewed. Amitriptyline and imipramine cause significant orthostatic hypotension and probably should be avoided in the elderly. In addition, amitriptyline is extremely anticholinergic. Amoxapine is essentially a neuroleptic sequelae, including tardive dyskinesia. If a patient has had a prior positive response or has a relative who had a good outcome from a particular drug, it may be best to begin treatment with that drug...
1989: Journal of Geriatric Psychiatry
G Hege-Scheuing
In this review we discuss the symptoms, etiology and therapy of reversible organic mental disorders following surgery. Acute confusional states and delirium still pose difficult and unsolved problems in our operative wards and intensive care units. They are a major cause of morbidity and mortality following geriatric surgery. It is necessary to keep a watchful eye for signs of mild cerebral impairment. Slight disorientation, minor fear, depression or delusions can be the first step towards an aggressive or delirious restlessness...
September 1989: Der Anaesthesist
J C Johnson
Delirium, an acute confusional state, is an organic brain syndrome that manifests deficits in attention, irrelevant or rambling speech, and other cognitive deficits. Its symptoms often fluctuate over the course of the day, and patients may be hyperactive--for example, restless and screaming--or hypoactive--for example, quiet, inactive, and stuporous. Occurring in approximately 20% of hospitalized elderly patients, delirium is the most common psychiatric syndrome in acutely ill general medical and surgical patients...
May 1990: Emergency Medicine Clinics of North America
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