Login to MyKarger

New to MyKarger? Click here to sign up.



Login with Facebook

Forgot your password?

Authors, Editors, Reviewers

For Manuscript Submission, Check or Review Login please go to Submission Websites List.

Submission Websites List

Institutional Login
(Shibboleth or Open Athens)

For the academic login, please select your country in the dropdown list. You will be redirected to verify your credentials.

Debate

The Cholinergic Deficiency Syndrome and Its Therapeutic Implications

Lemstra A.W. · Eikelenboom P. · van Gool W.A.

Author affiliations

Department of Neurology, Academic Medical Center, Amsterdam, The Netherlands

Related Articles for ""

Gerontology 2003;49:55–60

Do you have an account?

Login Information





Contact Information










I have read the Karger Terms and Conditions and agree.



Login Information





Contact Information










I have read the Karger Terms and Conditions and agree.



To view the fulltext, please log in

To view the pdf, please log in

Buy

  • FullText & PDF
  • Unlimited re-access via MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

CHF 38.00 *
EUR 35.00 *
USD 39.00 *

Select

KAB

Buy a Karger Article Bundle (KAB) and profit from a discount!

If you would like to redeem your KAB credit, please log in.


Save over 20% compared to the individual article price.
Learn more

Rent/Cloud

  • Rent for 48h to view
  • Buy Cloud Access for unlimited viewing via different devices
  • Synchronizing in the ReadCube Cloud
  • Printing and saving restrictions apply

Rental: USD 8.50
Cloud: USD 20.00


Select

Subscribe

  • Access to all articles of the subscribed year(s) guaranteed for 5 years
  • Unlimited re-access via Subscriber Login or MyKarger
  • Unrestricted printing, no saving restrictions for personal use
read more

Subcription rates


Select

* The final prices may differ from the prices shown due to specifics of VAT rules.

Article / Publication Details

First-Page Preview
Abstract of Debate

Received: May 21, 2002
Accepted: May 29, 2002
Published online: December 16, 2002
Issue release date: January – February

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 0

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: https://www.karger.com/GER

Abstract

Cholinesterase inhibitors are licensed for treatment of dementia in Alzheimer’s disease. However, the effects of these drugs on the cognitive symptoms of dementia are very small. We suggest that symptoms like impairment of attention and concentration, anxiety, restlessness and hallucinations, delineate a specific central cholinergic deficiency syndrome (CDS), that may be a much better target for such treatment. Changes in the quantitative electroencephalogram, muscarinic subtype radioimaging and serum anticholinergic activity may potentially help to diagnose the CDS. CDS is suggested to occur in various neurodegenerative diseases like Alzheimer’s disease, Lewy body dementia and Parkinson’s disease and to respond well to cholinesterase inhibitor therapy.

© 2003 S. Karger AG, Basel


References

  1. National Institute for Clinical Excellence: Guidance on the Use of Donepezil, rivastigmine and Galantamine for the Treatment of Alzheimer’s Disease. http://www.nice.org.uk.
  2. Birks JS, Melzer D, Beppu H: Donepezil for mild and moderate Alzeheimer’s disease (Cochrane Review); in The Cochrane Library, Issue 1, 2001. Oxford: Update Software.
  3. Olin J, Schneider L: Galantamine for Alzheimer’s disease (Cochrane Review); in the Cochrane Library, Issue 1, 2001. Oxford: Update Software.
  4. Birks J, Grimley EJ, Iakovidou V, Tsolaki M: Rivastigmine for Alzheimer’s disease (Cochrane Review); in The Cochrane Library, Issue 1, 2001. Oxford: Update Software.
  5. Committee for Proprietary Medical Products. Eurpean Public Assessment Report of Rivastigmine. http://www.eudra.org/emea.html.
  6. Hutchinson M, Fazzini E: Cholinesterase inhibition in Parkinson’s disease. J Neurol Neurosurg Psychiatry 1996;61:324–325.
  7. Aarsland D, Bronnick K, Karlsen K: Donepezil for dementia with Lewy bodies: A case study. Int J Geriatr Psychiatry 1999;14:69–72.
  8. McKeith J, Del Ser T, Spano P, Emre M, Wesnes K, Anand R, Cicin-Sian A, Ferrara R, Spiegel R: Efficacy of rivastigmine in dementia with Lewy bodies: A randomised, double-blind, placebo-controlled international study. Lancet 2000;356:2031–2036.
  9. Kaufer DI, Catt KE, Lopez OL, DeKosky ST: Dementia with Lewy bodies: Response of delirium-like features to donepezil. Neurology 1998;51:1512.
  10. Francis PT, Palmer AM, Snape M, Wilcock GK: The cholinergic hypothesis of Alzheimer’s disease: A review of progress. J Neurol Neurosurg Psychiatry 1999;66:137–147.
  11. Drachman DA, Leavitt J: Human memory and the cholinergic system. A relationship to aging? Arch Neurol 1974;30:113–121.
  12. Mesulam MM: The systems-level organization of cholinergic innervation in the cerebral cortex and its alterations in Alzheimer. Prog Brain Res 1996;109:285–298.
  13. Selden NR, Gitelman DR, Salamon-Murayama N, Parrish TB, Mesulam MM: Trajectories of cholinergic pathways within the cerebral hemispheres of the human brain. Brain 1998;121:2249–2257.
    External Resources
  14. Davies P, Maloney AJ: Selective loss of central cholinergic neurons in AD. Lancet 1976;ii:1403.
  15. Bowen DM, Smith CB, White P, Davison AN: Neurotransmitter-related enzymes and indices of hypoxia in senile dementia and other abiotrophies. Brain 1976;99:459–496.
  16. Perry EK, Gibson PH, Blessed G, Perry RH, Tomlinson BE: Neurotransmitter enzyme abnormalities in senile dementia. Choline acetyltransferase and glutamic acid decarboxylase activities in necropsy brain tissue. J Neurol Sci 1977;34:247–265.
  17. Whitehouse PJ, Price DL, Struble RG, Clark AW, Coyle JT, Delon MR: Alzheimer’s disease and senile dementia: Loss of neurons in the basal forebrain. Science 1982;215:1237–1239.
  18. Mesulam MM, Geula C: Nucleus basalis (Ch4) and cortical cholinergic innervation in the human brain: Observations based on the distribution of acetylcholinesterase and choline acetyltransferase. J Comp Neurol 1988;275:216–240.
  19. Ladner CJ, Lee JM: Pharmacological drug treatment of Alzheimer disease: The cholinergic hypothesis revisited. J Neuropathol Exp Neurol 1998;57:719–731.
  20. Coyle JT, Price DL, DeLong MR: Alzheimer’s disease: A disorder of cortical cholinergic innervation. Science 1983;219:1184–1190.
  21. Dringenberg HC: Alzheimer’s disease: More than ‘a cholinergic disorder’ – Evidence that cholinergic-monaminergic interactions contribute to EEG slowing and dementia. Behav Brain Res 2000;115:235–249.
  22. Davis KL, Mohs RC, Marin D, Purohit DP, Perl DP, Lantz M, Austin G, Haroutunian V: Cholinergic markers in elderly patients with early signs of Alzheimer disease. JAMA 1999;281:1401–1406.
  23. Gilmor ML, Erickson JD, Varoqui H, Hersh LB, Bennett DA, Cochran EJ, Mufson EJ, Levey AI: Preservation of nucleus basalis neurons containing choline acetyltransferase and the vesicular acetylcholine transporter in the elderly with mild cognitive impairment and early Alzheimer’s disease. J Comp Neurol 1999;411:693–704.
  24. Minger SL, Honer WG, Esiri MM, McDonald B, Keene J, Nicoll JA, Carter J, Hope T, Francis PT: Synaptic pathology in prefrontal cortex is present only with severe dementia in Alzheimer disease. J Neuropathol Exp Neurol 2001;60:929–936.
  25. Selkoe DJ: Alzheimer’s disease: Genes, proteins and therapy. Physiol Rev 2001;81:741–766.
  26. Liberini P, Valerio A, Memo M, Spano PF: Lewy-body dementia and responsiveness to cholinesterase inhibitors: A paradigm for heterogeneity of Alzheimer’s disease? Trends Pharmacol Sci 1996;17:155–160.
    External Resources
  27. Maurer K, Volk S, Gerbaldo H: Auguste D and Alzheimer’s disease. Lancet 1997;349:1546–1549.
  28. Albert ML: Subcortical dementia; in Katzman et al (eds): Alzheimer’s Disease: Senile Dementia and Related Disorders. New York, Raven Press, 1978, pp 173–180.
  29. Cummings JL: Introducion; in Cummings JL (ed): Subcortical Dementia. New York, Oxford University Press, 1990, pp 3–16.
  30. Sarter M, Bruno JP: Cognitive functions of cortical acetylcholine: Toward a unifying hypothesis. Brain Res Rev 1997;23:28–46.
  31. Perry E, Walker M, Grace J, Perry R: Acetylcholine in mind: A neurotransmitter correlate of consciousness? Trends Neurosci 1999;22:273–280.
    External Resources
  32. Nakano I, Hirano A: Parkinson’s disease: Neuron loss in the nucleus basalis without concomitant Alzheimer’s disease. Ann Neurol 1984;15:415–418.
  33. Perry EK, Morris CM, Court JA, Cheng A, Fairbairn AF, McKeith IG, Irving D, Brown A, Perry RH: Alteration in nicotine binding sites in Parkinson’s disease, Lewy body dementia and Alzheimer’s disease: Possible index of early neuropathology. Neuroscience 1995;64:385–395.
    External Resources
  34. Perry EK, Perry RH: Acetylcholine and hallucinations: Disease-related compared to drug-induced alterations in human consciousness. Brain Cogn 1995;28:240–258.
  35. Forstl H, Burns A, Levy R, Cairns N, Luthert P, Lantos P: Neuropathological correlates of behavioural disturbance in confirmed Alzheimer’s disease. Br J Psychiatry 1993;163:364–368.
  36. Perry EK, Irving D, Kerwin JM, McKeith IG, Thompson P, Collerton D, Fairbairn AF, Ince PG, Morris CM, Cheng AV: Cholinergic transmitter and neurotrophic activities in Lewy body dementia: Similarity to Parkinson’s and distinction from Alzheimer disease. Alzheimer Dis Assoc Disord 1993;7:69–79.
  37. Levy R, Eagger S, Griffiths M, Perry E, Honavar M, Dean A, Lantos P: Lewy bodies and response to tacrine in Alzheimer’s disease. Lancet 1994;343:176.
  38. Whitehouse PJ, Hedreen JC, White CL 3rd, Price DL: Basal forebrain neurons in the nucleus of Meynert in dementia of Parkinson’s disease. Ann Neurol 1983;13:243–248.
  39. Goetz CG, Pappert EJ, Blasucci LM, Stebbins GT, Ling ZD, Nora MV, Carvey PM: Intravenous levodopa in hallucinating Parkinson’s disease patients: High-dose challenge does not precipitate hallucinations. Neurology 1998;50:515–517.
  40. Schwab RS, Faing HD, Prichard JS: Psychiatric symptoms and syndromes in Parkinson’s disease. Am J Psychiatry 1951;107:901–907.
  41. Pourcher E: Cholinesterase inhibitor trial in neurobehavioral disorders associated with Parkinsonism (abstract). Sixth International Stockholm/Springfield Symposium on Advances in Alzheimer Therapy, 2000, p 224.
  42. Korzcyn AD: Dementia in Parkinson’s disease. J Neurol 2001;248(suppl 3):1–4.
  43. Korczyn AD: Hallucinations in Parkinson’s disease. Lancet 2001;358:1031–1032.
  44. Forrer GR, Miler JJ: Atropine coma: A somatic therapy in psychiatry. Am J Psychiatry 1958;115:455–458.
  45. Itil T, Fink M: Anticholinergic drug-induced delirium: Experimental modification, quantitative EEG and behavioral correlations. J Nerv Ment Dis 1966;143:492–507.
  46. Callaway EBRI III: Some psychopharmacological effects of atropine. Arch Neurol Psychiatry 1958;79:91–102.
  47. Tune LE, Egeli S: Acetylcholine and delirium. Dement Geriatr Cogn Disord 1999;10:342–344.
  48. Trzepacz PT: Is there a final common neural pathway in delirium? Focus on acetylcholine and dopamine. Semin Clin Neuropsychiatry 2000;5:132–148.
  49. Kikuchi M, Wada Y, Nanbu Y, Nakajima A, Tachibana H, Takeda T, Hashimoto T: EEG changes following scopolamine administration in healthy subjects. Quantitative analysis during rest and photic stimulation. Neuropsychobiology 1999;39:219–226.
  50. Stewart DJ, MacFabe DF, Vanderwolf CH: Cholinergic activation of the electrocorticogram: Role of the substantia innominata and effects of atropine and quinuclidinyl benzilate. Brain Res 1984;322:219–232.
  51. McPherson DW, Greenbaum M, Luo H, Beets AL, Knapp FF Jr: Evaluation of Z-(R,R)-IQNP for the potential imaging of m2 mAChR-rich regions of the brain and heart. Life Sci 2000;66:885–896.

Article / Publication Details

First-Page Preview
Abstract of Debate

Received: May 21, 2002
Accepted: May 29, 2002
Published online: December 16, 2002
Issue release date: January – February

Number of Print Pages: 6
Number of Figures: 1
Number of Tables: 0

ISSN: 0304-324X (Print)
eISSN: 1423-0003 (Online)

For additional information: https://www.karger.com/GER


Copyright / Drug Dosage / Disclaimer

Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher.
Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug.
Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.