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Palma JA, Gupta A, Sierra S, Gomes I, Balgobin B, Norcliffe-Kaufmann L, Devi LA, Kaufmann H. Autoantibodies Blocking M 3 Muscarinic Receptors Cause Postganglionic Cholinergic Dysautonomia. Ann Neurol 2020; 88:1237-1243. [PMID: 32833276 DOI: 10.1002/ana.25882] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 08/19/2020] [Accepted: 08/19/2020] [Indexed: 12/31/2022]
Abstract
A 10-year-old girl presented with ileus, urinary retention, dry mouth, lack of tears, fixed dilated pupils, and diffuse anhidrosis 7 days after a febrile illness. We hypothesized that her syndrome was due to autoimmunity against muscarinic acetylcholine receptors, blocking their activation. Using an indirect enzyme-linked immunosorbent assay for all 5 muscarinic receptors (M1 -M5 ), we identified in the patient's serum antibodies that selectively bound to M3 receptors. In vitro functional studies confirmed that these autoantibodies selectively blocked M3 receptor activation. Thus, autoantibodies against M3 acetylcholine receptors cause acute postganglionic cholinergic dysautonomia. ANN NEUROL 2020;88:1237-1243.
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Affiliation(s)
- Jose-Alberto Palma
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
| | - Achla Gupta
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Salvador Sierra
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Ivone Gomes
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Bhumika Balgobin
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
| | - Lucy Norcliffe-Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
| | - Lakshmi A Devi
- Department of Pharmacological Sciences, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Horacio Kaufmann
- Department of Neurology, Dysautonomia Center, New York University School of Medicine, New York, New York, USA
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2
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Navarro NM, Krawczyk MC, Boccia MM, Blake MG. Extinction and recovery of an avoidance memory impaired by scopolamine. Physiol Behav 2017; 171:192-198. [PMID: 28069463 DOI: 10.1016/j.physbeh.2016.12.042] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Revised: 12/07/2016] [Accepted: 12/20/2016] [Indexed: 11/29/2022]
Abstract
Pre-training administration of scopolamine (SCP) resembles situations of cholinergic dysfunction, leading to memory impairment of mice trained in an inhibitory avoidance task. We suggest here that SCP does not impair memory formation, but acquisition is affected in a way that reduces the strength of the stored memory, thus making this memory less able to control behavior when tested. Hence, a memory trace is stored, but is poorly expressed during the test. Although weakly expressed, this memory shows extinction during successive tests, and can be strengthened by using a reminder. Our results indicate that memories stored under cholinergic dysfunction conditions seem absent or lost, but are in fact present and experience common memory processes, such as extinction, and could be even recovered by using appropriate protocols.
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Affiliation(s)
- N M Navarro
- Universidad de Buenos Aires, CONICET, Facultad de Medicina, Departamento de Fisiología, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO), Paraguay, 2155, 7th floor, C1121ABG, Buenos Aires, Argentina
| | - M C Krawczyk
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Farmacología, Junín, 956, 5th floor, C1113AAC, Buenos Aires, Argentina
| | - M M Boccia
- Universidad de Buenos Aires, Facultad de Farmacia y Bioquímica, Cátedra de Farmacología, Junín, 956, 5th floor, C1113AAC, Buenos Aires, Argentina
| | - M G Blake
- Universidad de Buenos Aires, CONICET, Facultad de Medicina, Departamento de Fisiología, Instituto de Fisiología y Biofísica Bernardo Houssay (IFIBIO), Paraguay, 2155, 7th floor, C1121ABG, Buenos Aires, Argentina.
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3
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Hescham S, Temel Y, Casaca-Carreira J, Arslantas K, Yakkioui Y, Blokland A, Jahanshahi A. A neuroanatomical analysis of the effects of a memory impairing dose of scopolamine in the rat brain using cytochrome c oxidase as principle marker. J Chem Neuroanat 2014; 59-60:1-7. [PMID: 24768696 DOI: 10.1016/j.jchemneu.2014.04.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2013] [Revised: 04/08/2014] [Accepted: 04/10/2014] [Indexed: 12/13/2022]
Abstract
Acetylcholine plays a role in mnemonic and attentional processes, but also in locomotor and anxiety-related behavior. Receptor blockage by scopolamine can therefore induce cognitive as well as motor deficits and increase anxiety levels. Here we show that scopolamine, at a dose that has previously been found to affect learning and memory performance (0.1 mg/kg i.p.), has a widespread effect on cytochrome c oxidase histochemistry in various regions of the rat brain. We found a down-regulation of cytochrome c oxidase in the nucleus basalis, in movement-related structures such as the primary motor cortex and the globus pallidus, memory-related structures such as the CA1 subfield of the hippocampus and perirhinal cortex and in anxiety-related structures like the amygdala, which also plays a role in memory. However choline acetyltransferase levels were only affected in the CA1 subfield of the hippocampus and both, choline acetyltransferase and c-Fos expression levels were decreased in the amygdala. These findings corroborate strong cognitive behavioral effects of this drug, but also suggest possible anxiety- and locomotor-related changes in subjects. Moreover, they present histochemical evidence that the effects of scopolamine are not ultimately restricted to cognitive parameters.
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Affiliation(s)
- Sarah Hescham
- Department of Neuroscience, Maastricht University, Maastricht, The Netherlands; European Graduate School of Neuroscience (Euron), The Netherlands.
| | - Yasin Temel
- Department of Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Neurosurgery, Maastricht University, Maastricht, The Netherlands; European Graduate School of Neuroscience (Euron), The Netherlands
| | - João Casaca-Carreira
- Department of Neuroscience, Maastricht University, Maastricht, The Netherlands; European Graduate School of Neuroscience (Euron), The Netherlands
| | - Kemal Arslantas
- Department of Neuroscience, Maastricht University, Maastricht, The Netherlands
| | - Youssef Yakkioui
- Department of Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Neurosurgery, Maastricht University, Maastricht, The Netherlands; European Graduate School of Neuroscience (Euron), The Netherlands
| | - Arjan Blokland
- Department of Neuropsychology and Psychopharmacology, University of Maastricht, The Netherlands; European Graduate School of Neuroscience (Euron), The Netherlands
| | - Ali Jahanshahi
- Department of Neuroscience, Maastricht University, Maastricht, The Netherlands; Department of Neurosurgery, Maastricht University, Maastricht, The Netherlands; European Graduate School of Neuroscience (Euron), The Netherlands.
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4
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Abstract
Molecular imaging represents a bridge between basic and clinical neuroscience observations and provides many opportunities for translation and identifying mechanisms that may inform prevention and intervention strategies in late-life depression (LLD). Substantial advances in instrumentation and radiotracer chemistry have resulted in improved sensitivity and spatial resolution and the ability to study in vivo an increasing number of neurotransmitters, neuromodulators, and, importantly, neuropathological processes. Molecular brain imaging studies in LLD will be reviewed, with a primary focus on positron emission tomography. Future directions for the field of molecular imaging in LLD will be discussed, including integrating molecular imaging with genetic, neuropsychiatric, and cognitive outcomes and multimodality neuroimaging.
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Affiliation(s)
- Kentaro Hirao
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
- Department of Geriatric Medicine, Tokyo Medical University, Tokyo, Japan
| | - Gwenn S. Smith
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, MD, USA
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5
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Serum anticholinergic activity: a possible peripheral marker of the anticholinergic burden in the central nervous system in Alzheimer's disease. DISEASE MARKERS 2014; 2014:459013. [PMID: 24665147 PMCID: PMC3934106 DOI: 10.1155/2014/459013] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 12/15/2013] [Accepted: 12/29/2013] [Indexed: 11/17/2022]
Abstract
We review the utility of serum anticholinergic activity (SAA) as a peripheral marker of anticholinergic activity (AA) in the central nervous system (CAA). We hypothesize that the compensatory mechanisms of the cholinergic system do not contribute to SAA if their system is intact and that if central cholinergic system deteriorates alone in conditions such as Alzheimer's disease or Lewy body dementia, CAA and SAA are caused by way of hyperactivity of inflammatory system and SAA is a marker of the anticholinergic burden in CNS. Taking into account the diurnal variations in the plasma levels of corticosteroids, which are thought to affect SAA, it should be measured at noon or just afterward.
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Dissociation between memory reactivation and its behavioral expression: Scopolamine interferes with memory expression without disrupting long-term storage. Neurobiol Learn Mem 2012; 98:235-45. [DOI: 10.1016/j.nlm.2012.08.003] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2012] [Revised: 08/01/2012] [Accepted: 08/12/2012] [Indexed: 11/18/2022]
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Abstract
Wider use of pharmacological models would facilitate the development of new drugs for Alzheimer's disease (AD), The two main models currently used are based on the cholinergic and glutamatergic hypotheses of AD, Although they lead to some of the attention and memory impairment observed in AD, they do not fully reproduce the AD pattern. The few studies that used a combination modeling approach, ie, the simultaneous administration of several drugs with the aim of impairing several neurotransmitters or different aspects of a single system, have reported no or marginal cumulative effect. On the basis of current understanding of glutamate and acetylcholine involvement in AD pathophysiology, we suggest that models using selective muscarinic-1 (M(1)) receptor blockers would better mimic the status of the cholinergic system in AD, This kind of model might be suitable for the assessment of drugs that do not act directly on the cholinergic system.
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Affiliation(s)
- C Gilles
- CNS Aging Research, FORENAP - Institute for Research in Neuroscience and Neuropsychiatry, Rouffach, France
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Blake M, Boccia M, Krawczyk M, Delorenzi A, Baratti C. Choline reverses scopolamine-induced memory impairment by improving memory reconsolidation. Neurobiol Learn Mem 2012; 98:112-21. [DOI: 10.1016/j.nlm.2012.07.001] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2012] [Revised: 06/18/2012] [Accepted: 07/01/2012] [Indexed: 10/28/2022]
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9
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The differential effects of equipotent doses of isoflurane and desflurane on hippocampal acetylcholine levels in young and aged rats. Neurosci Lett 2010; 471:166-70. [DOI: 10.1016/j.neulet.2010.01.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2009] [Revised: 01/12/2010] [Accepted: 01/14/2010] [Indexed: 11/21/2022]
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Praticò C, Quattrone D, Lucanto T, Amato A, Penna O, Roscitano C, Fodale V. Drugs of anesthesia acting on central cholinergic system may cause post-operative cognitive dysfunction and delirium. Med Hypotheses 2005; 65:972-82. [PMID: 16043305 DOI: 10.1016/j.mehy.2005.05.037] [Citation(s) in RCA: 74] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2005] [Accepted: 05/19/2005] [Indexed: 11/30/2022]
Abstract
Given the progressive and constant increase of average life expectancy, an increasing number of elderly patients undergo surgery. After surgery, elderly patients often exhibit a transient reversible state of cerebral cognitive alterations. Among these cognitive dysfunctions, a state of delirium may develop. Delirium is an aetiologically non-specific syndrome characterised by concurrent disturbances of consciousness and attention, perception, thinking, memory, psychomotor behaviour and the sleep-wake cycle. Delirium appears to occur in 10-26% of general medical patients over 65, and is frequently associated with a significant increase in morbidity and mortality. During hospitalization, mortality rates have been estimated to be 10-26% of patients who developed post-operative delirium, and 22-76% during the following months. Over the last few decades, post-operative delirium has been associated with several pre-operative predictor factors, as well as age (50 years and older), alcohol abuse, poor cognitive and functional status, electrolyses or glucose abnormalities, and type of surgery. The uncertain pathogenesis of post-operative cognitive dysfunctions and delirium has not permitted a causal approach to developing an effective treatment. General anesthesia affects brain function at all levels, including neuronal membranes, receptors, ion channels, neurotransmitters, cerebral blood flow and metabolism. The functional equivalents of these impairments involve mood, memory, and motor function behavioural changes. These dysfunctions are much more evident in the occurrence of stress-regulating transmission and in the alteration of intra-cellular signal transduction systems. In addition, more essential cellular processes, that play an important role in neurotransmitter synthesis and release, such as intra-neuronal signal transduction and second messenger system, may be altered. Keeping in mind the functions of the central muscarinic cholinergic system and its multiple interactions with drugs of anesthesia, it seems possible to hypothesize that the inhibition of muscarinic cholinergic receptors could have a pivotal role in the pathogenesis not only of post-operative delirium but also the more complex phenomena of post-operative cognitive dysfunction.
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Affiliation(s)
- C Praticò
- Department of Neuroscience, Psychiatric and Anesthesiological Sciences, University of Messina, School of Medicine, Policlinico Universitario G. Martino, via C.Valeria, 98125 Messina, Italy
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11
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Jansson A, Olin K, Yoshitake T, Hagman B, Herrington MK, Kehr J, Permert J. Effects of isoflurane on prefrontal acetylcholine release and hypothalamic Fos response in young adult and aged rats. Exp Neurol 2004; 190:535-43. [PMID: 15530892 DOI: 10.1016/j.expneurol.2004.08.027] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2003] [Revised: 07/23/2004] [Accepted: 08/24/2004] [Indexed: 11/22/2022]
Abstract
This experiment investigated the influence of age on prefrontal acetylcholine (ACh) release and Fos response in the hypothalamic paraventricular nucleus and the nucleus tractus solitarius (NTS) of rats following isoflurane anesthesia. It is known that isoflurane decreases acetylcholine release in most brain regions. In the present study, we found that the level of prefrontal acetylcholine was significantly lower in 28-month-old rats (14% of baseline) than in 3-month-old rats (38% of baseline) during 2 h of isoflurane anesthesia (P < 0.05). The old rat group showed significantly greater Fos induction in the paraventricular nucleus compared to the young adult rat group (P < 0.05), indicating that the old rats were subjected to stress. No difference in Fos response was noted in the nucleus tractus solitarius. The old rats displayed a significant increase in feeding behavior during the 3-h recovery period (P < 0.05), but there was no difference in overall acetylcholine levels. Taken together, these findings suggest that isoflurane anesthesia influences old rats more profoundly than young adult rats with regard to reductions in acetylcholine release and stress responses. This may have implications for understanding the development of postoperative delirium in aged patients.
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Affiliation(s)
- A Jansson
- Center for Surgical Sciences, Karolinska Institutet, Karolinska University Hospital, Huddinge, 141 86 Stockholm, Sweden.
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12
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Abstract
Despite the growing means devoted to research and development (R α D) and refinements in the preclinical stages, the efficiency of central nervous system (CMS) drug development is disappointing. Many drugs reach patient studies with an erroneous therapeutic indication andlor in incorrect doses. Apart from the first clinical studies, which are conducted in healthy volunteers and focus only on safety, iolerability, and pharmacokinetics, drug development mostly relies on patient studies. Psychiatric disorders are characterized by heterogeneity and a high rate of comorbidity. It is becoming increasingly difficult to recruit patients for clinical trials and there are many confounding factors in this population, for example, those related to treatments. In order to keep patient exposure and financial expenditure to a minimum, it is important to avoid ill-designed and inconclusive studies. This risk could be minimized by gathering pharmacodynamic data earlier in development and considering that the goal of a phase 1 plan is to reach patient studies with clear ideas about the compound's pharmacodynamic profile, its efficacy in the putative indication (proof of concept), and pharmacokinetic/pharmacodynamic relationships, in addition to safety, tolerability, and pharmacokinetics. Human models in healthy volunteers may be useful tools for this purpose, but their use necessitates a global adaptation of the phase scheme, favoring pharmacodynamic assessments without neglecting safety. We are engaged in an R α D program aimed to adapt existing models and develop new paradigms suitable for early proof of concept substantiation.
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Kennedy JS, Zagar A, Bymaster F, Nomikos G, Trzepacz PT, Gilmore JA, Rotelli MD, Breier A, Tollefson G. The central cholinergic system profile of olanzapine compared with placebo in Alzheimer's disease. Int J Geriatr Psychiatry 2001; 16 Suppl 1:S24-32. [PMID: 11748787 DOI: 10.1002/1099-1166(200112)16:1+<::aid-gps570>3.0.co;2-8] [Citation(s) in RCA: 19] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The objective of this analysis was to compare the treatment-emergent central anticholinergic-like adverse events experienced during treatment with olanzapine versus placebo in patients with psychosis and/or agitation due to Alzheimer's disease (AD). In addition, changes in cognition were assessed in a subgroup of patients with mild to moderate cognitive impairment. METHODS Double-blind data were compared for placebo and three fixed olanzapine dosages (5 mg/day, 10 mg/day, and 15 mg/day) in 206 nursing home-residing patients with AD for five a priori selected central nervous system anticholinergic-like adverse events: confusion, delirium, delusions, hallucinations, abnormal thinking. Mean change from baseline to endpoint on the Alzheimer's Disease Assessment Scale-Cognitive (ADAS-Cog) was measured for a subgroup of 43 patients who had mild to moderate cognitive impairment at baseline. RESULTS There were no significant differences in central anticholinergic-like adverse events at any olanzapine dose compared to placebo. Additionally, in the 43-patient subgroup, there were no significant differences in mean change in ADAS-Cog scores between placebo and the three olanzapine dose subgroups. CONCLUSION Olanzapine did not differ significantly from placebo for any of the five central nervous system anticholinergic events nor on the ADAS-Cog. Olanzapine's initially reported potent in vitro muscarinic receptor affinity is not consistent with this clinical study of central nervous system anticholinergic-like adverse events in patients with AD.
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Affiliation(s)
- J S Kennedy
- Lilly Research Laboratories, Eli Lilly and Company, Lilly Corporate Center, Indianapolis, Indiana 46285, USA.
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Tariot PN, Patel SV, Cox C, Henderson RE. Age-related decline in central cholinergic function demonstrated with scopolamine. Psychopharmacology (Berl) 1996; 125:50-6. [PMID: 8724448 DOI: 10.1007/bf02247392] [Citation(s) in RCA: 42] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
Scopolamine hydrobromide was administered intravenously to 23 normal subjects (40-89 years) in doses of 0.1 mg, 0.25 mg, and 0.5 mg, in a double-blind. Placebo-controlled, random-order fashion. The effects of scopolamine, as compared to placebo, were assessed using a comprehensive cognitive test battery, as well as behavioral and physiological measures. Scopolamine produced the expected dose-dependent impairments in most of the cognitive functions assessed. Behavioral and physiological measures were also affected, but only minimally. More importantly, there was a significant overall correlation between age and scopolamine-impaired performances on psychomotor speed, short-term recall, visual tracking speed, visuo-motor coordination, and sequencing ability. There was, however, some inter-individual variability in this phenomenon. The results provide further evidence that cholinergically mediated cognitive functions show an increased sensitivity to scopolamine with age, albeit with heterogeneity that bears further investigation.
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Affiliation(s)
- P N Tariot
- Department of Psychiatry, University of Rochester School of Medicine and Dentistry, New York, USA
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Sarter M, Schneider HH, Stephens DN. Treatment strategies for senile dementia: antagonist beta-carbolines. Trends Neurosci 1988; 11:13-7. [PMID: 2469147 DOI: 10.1016/0166-2236(88)90042-2] [Citation(s) in RCA: 81] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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