The Medicare Utilization Review Committee conducted a survey to determine the use of drugs with anticholinergic effects in confused elderly nursing home patients. Twenty-nine patients (34.5 percent) were receiving anticholinergic drugs, predominantly from the antidepressant and antipsychotic class. Thioridazine (Mellaril) was the most frequently used antipsychotic. No patients received higher than the equivalent recommended daily dose of atropine when calculated in terms of relative anticholinergic potency. No statistically significant correlation could be found between the presence of confusion and the amount of anticholinergics administered. Confusion and cognitive deterioration frequently are encountered when caring for aged patients. Clinical experience and recent studies suggest that anticholinergics may increase the risk of or exacerbate existing confusion, and this possible effect of anticholinergic activity should be considered when prescribing for elderly patients.
SchneckMKReisbergGFerrisSH. Neurotransmitter treatment of senile dementia, Alzheimer's type. Int Drug Ther Newslett1981; 16: 2.
2.
KatzmanRKarasuT. Differential diagnosis of dementia. In: FieldsWS, ed. Neurological and sensory disorders in the elderly. New York: Stratton Intercontinental Medical Book Corp., 1975: 103–4.
3.
JarvikLRuthVMatsuyamaS. Organic brain syndrome and aging: A six year follow-up of surviving twins. Am J Psychiatry1980; 137: 280–6.
4.
SeltzerBSherwinI. Organic brain syndromes: An empirical study and critical review. Am J Psychiatry1978; 135: 13–21.
5.
DaviesPMaloneyAJF. Selective loss of central cholinergic neurons in Alzheimer's disease. Lancet1976; 2: 1403.
6.
Cholinergic involvement in senile dementia (editorial). Lancet1977; 1: 408.
7.
SmithCMSwashM. Possible biochemical basis of memory disorder in Alzheimer's disease. Ann Neurol1978; 3: 471–3.
8.
TomlinsonBEBlessedGRothM. Observations on the brains of demented old people. J Neurol Sci1970; 11: 205–42.
DrachmanDALeavittJ. Human memory and the cholinergic system: A relationship to aging?. Arch Neurol1974; 30: 113–21.
11.
DrachmanDASahakianBJ. Memory and cognitive function in the elderly: A preliminary trial of physostigmine. Arch Neurol1980; 37: 674–5.
12.
DavisKMohsRDavisBHorvathTHuman memory and the effects of physostigmine and choline chloride. Psychopharmacol Bull1980; 116: 27–8.
13.
GhoneimMMewaldtS. Studies on human memory: The interactions of diazepam, scopolamine and physostigmine. Psychopharmacol1977; 52: 1–6.
14.
JohnsonAHollisterLBergerP. The anticholinergic intoxication syndrome: Diagnosis and treatment. J Clin Psychiatry1981; 42: 313–7.
15.
HallRFeinsilverDHoltR. Anticholinergic psychosis: Differential diagnosis and management. Psychosomatics1981; 22: 581–7.
16.
PetersBLevinH. Effects of physostigmine and lecithin on memory in Alzheimer's disease. Ann Neurol1979; 6: 219–21.
17.
CrowTGrove-WhiteI. An analysis of the learning deficit following hyoscine administration to man. Br J Pharmacol1973; 49: 322–7.
18.
SnyderSHYamamuraHL. Antidepressants and the muscarinic acetylcholine receptor. Arch Gen Psychiatry1977; 34: 236–9.
19.
SnyderSHGreenbergDYamamuraHL. Antischizophrenic drugs and brain cholinergic receptors. Arch Gen Psych1974; 31: 58–61.
20.
RosenHJ. Double-blind comparison of haloperidol and thioridazine in geriatric outpatients. J Clin Psychiatry1979; 40: 17–20.
21.
TobinJMBrousseauERLorenzAA. Clinical evaluation of haloperidol in geriatric patients. Geriatrics1970; 25: 119–22.
22.
BarnesRRaskindM. Strategies for diagnosing and treating agitation in the aging. Geriatrics1980; 35: 111–9.
23.
YesavageJ. Dementia: Differential diagnosis and treatment. Geriatrics1979; 34: 51–9.
24.
HartfordJ. How to minimize side effects of psychotropic drugs. Geriatrics1980; 35: 83–93.
25.
FannWE. Pharmacotherapy in older depressed patients. J Gerontol1976; 34: 304.
26.
VestalRE. Drug use in the elderly: A review of problems and special considerations. Drugs1979; 16: 358–82.
27.
ZeokaJO'MalleyKStevensonIH. Pharmacokinetics in the elderly. Clin Pharmacokinet1976; 1: 280–96.
28.
BenderAD. Pharmacodynamic principles of drug therapy in the aged. J Am Geriatr Soc1974; 22: 296–303.
29.
TriggsEJNationRL. Pharmacokinetics in the aged: A review. J Pharmacokinet Biopharm1975; 3: 387–417.
30.
RicheyDPBenderAD. Pharmacokinetic consequences of aging. Annu Rev Pharmacol Toxicol1977; 17: 49–65.
31.
ShaderRIGreenblattDJ. Pharmacokinetics and clinical drug effects in the elderly. Psychopharmacol Bull1979; 15: 8–14.
32.
HickRDyskenMWDavisJMThe pharmacokinetics of psychotropic medication in the elderly: A review. J Clin Psychiatry1981; 34: 374–85.
33.
TuneLCoyleJT. Serum levels of anticholinergic drugs in treatment of acute extrapyramidal side effects. Arch Gen Psychiatry1980; 37: 293–7.
34.
RichterJAPerryEKTomlinsonBE. Acetylcholine and choline levels in post-mortem human brain tissue: Preliminary observations in Alzheimer's disease. Life Sci1980; 26: 1683–9.
35.
ReisbergBFerrisSHGershonS. An overview of pharmacologic treatment of cognitive decline in the aged. Am J Psychiatry1981; 138: 593–600.
36.
FriedmanEShermanKAFerrisSHClinical response to choline plus piracetam in senile dementia: Relation to red-cell choline levels. N Engl J Med1981; 304: 1490.
37.
BowenDMSimsNRBentonJSTreatment of Alzheimer's disease: A cautionary note. N Engl J Med1981; 305: 1061.
