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Adverse Effects in Long-term Anticholinergic Medication Exposure
Long-term anticholinergic medication exposure can cause long-term consequences that surpass previously documented short-term cognitive effects, according to a review recently published in the Journal of Neurochemistry.
Anticholinergic medications, medications used to block the action of the neurotransmitter acetylcholine in the central and autonomic nervous systems, are commonly prescribed to seniors and are known to cause both positive and adverse effects.
“Recent evidence has linked long-term use of anticholinergic medications and dementia. Emerging evidence implicates the cholinergic system in the regulation of cerebral vasculature as well as neuroinflammation, suggesting that anticholinergic medications may contribute to absolute risk and progression of neurodegenerative diseases,” wrote Sina Marzoughi, MD, BScH, Division of Neurology, Department of Medicine, University of British Columbia, Vancouver, BC, Canada, and co-authors.
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Researchers aimed to outline common anticholinergic medications, compile evidence on long-term or tardive effects as well as evidence of long-term effects on the onset and progression of neurological diseases, and uncover mechanisms causing a relationship between neurological diseases and anticholinergic medications.
Researchers took references from human and animal studies dated between January 1990 and September 2020 from the PubMed and Cochrane databases. Randomized clinical trials, meta-analyses, systematic reviews, and observational studies were included.
Researchers analyzed the relationship of anticholinergic medications for the treatment of amyotrophic lateral sclerosis, Parkinson disease (PD), dementia, and other neurological disorders, including spinal cord injury and epilepsy.
Researchers wrote that exploring a relationship between the progression of amyotrophic lateral sclerosis and anticholinergic medication burden could yield results, as reviewing current data showed involvement of cholinergic receptors at multiple levels of the nervous system.
While there are no data on the association of a greater risk of PD onset and anticholinergic medications, “further studies are warranted to explore possible associations between anticholinergic medication use and PD onset and progression, particularly given the significant cholinergic system dysfunction seen in PD,” Dr Marzoughi wrote.
Results showed long-term anticholinergic medication use may be associated with cases of Alzheimers disease and dementia, and “[c]hronic protracted (or even permanent) adverse effects included tardive dyskinesia (TD), persisting after drug discontinuation and governed by pharmacodynamic considerations—the chronic effect of the drug on the architecture of the brain, which likely involves transcriptome changes.”
“With newly found involvement of muscarinic receptors in mediating neuroinflammation as well as cerebral vasculature, further study into the effects of these medications on other neurodegenerative conditions as well as better determining the mechanism of action of their detrimental effects is required,” concluded Dr Marzoughi et al.
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