Serum anticholinergicity is associated with reduced prefrontal brain function in early course schizophrenia

Effect of anticholinergic burden on brain activity during Working Memory and real-world functioning in patients with schizophrenia

Cognitive impairment has been associated with poor real-world functioning in patients with Schizophrenia. Previous studies have shown that pharmacological treatment with anticholinergic properties may contribute to cognitive impairment in Schizophrenia. We investigated the effect of the anticholinergic burden (ACB) on brain activity, cognition, and real-world functioning in Schizophrenia. We hypothesized that greater ACB would be associated with altered brain activity along with poorer cognitive performance and lower real-world functioning. A sample of 100 patients with a diagnosis of schizophrenia or schizoaffective disorder was recruited in the naturalistic multicenter study of the Italian Network for Research on Psychoses (NIRP) across 7 centres. For each participant, ACB was evaluated using the Anticholinergic Cognitive Burden scale. The association of ACB with brain function was assessed using BOLD fMRI during the N-Back Working Memory (WM) task in a nested cohort (N = 31). Real-world functioning was assessed using the Specific Level of Functioning (SLOF) scale. Patients with high ACB scores (≥3) showed lower brain activity in the WM frontoparietal network (TFCE corrected alpha <0.05) and poorer cognitive performance (p = 0.05) than patients with low ACB scores (<3). Both effects were unaffected by demographic characteristics, clinical severity, and antipsychotic dosage. Moreover, patients with high ACB showed poorer real-world functioning than patients with lower ACB (p = 0.03). Our results suggest that ACB in Schizophrenia is associated with impaired WM and abnormal underlying brain function along with reduced real-world functioning. Clinical practice should consider the potential adverse cognitive effects of ACB in the treatment decision-making process.

Smoking affects the association between cognitive impairment and P50 inhibition defects in patients with chronic schizophrenia: A case-control study

OBJECTIVE

Smoking affects sensory gating, as assessed by the event related potential P50, which is evoked by auditory stimuli and is considered to be involved in the pathophysiology of schizophrenia (SCZ). However, few studies have compared sensory gating and cognitive performance between smoking and non-smoking SCZ patients in the Chinese Han population.

METHODS

We recruited two groups of Chinese subjects: 128 male chronic SCZ patients and 76 male healthy controls, measuring cognition with the MATRICS Consensus Cognitive Battery (MCCB) and sensory gating with the P50 EEG components. Based on their smoking status, they were further divided into 4 subgroups: smoking SCZ patients, non-smoking SCZ patients, smoking healthy controls, and non-smoking healthy controls. We assessed psychopathological symptoms of the patients using the Positive and Negative Syndrome Scale (PANSS).

RESULTS

Compared with healthy controls, SCZ patients had lower MCCB total score and scores of all 10 tests (all p < 0.05), while SCZ patients had higher S2 amplitudes and P50 ratios (both p < 0.05). When comparing smoking versus non-smoking SCZ patients, non-smokers had significantly better spatial span (p < 0.05). Furthermore, the S1 amplitude was negatively correlated with the Brief Visuospatial Memory Test (BVMT-R) in smoking patients (p < 0.05), while the S1 latency was negatively correlated with spatial span in non-smoking patients (p < 0.01).

CONCLUSIONS

Our finding shows a difference in the relationship between sensory gated P50 and cognition in smoking and non-smoking SCZ patients, suggesting that nicotine may improve cognitive and P50 deficits in SCZ patients.

Protocol for a multicenter randomized, double blind, controlled pilot trial of higher neural function in overactive bladder patients after anticholinergic, beta-3 adrenergic agonist, or placebo

Introduction

Overactive bladder (OAB) syndrome has a negative impact on quality of life and prevalence increases with advanced age. Anticholinergics (AC) and beta-3 adrenergic agonists (β3a) are commonly prescribed medications for treatment of OAB. AC medication has been associated with dementia in population studies and with cortical atrophy in imaging studies. Higher neural effects of both classes of OAB medications have not been evaluated with functional neuroimaging. Longitudinal clinical assessments of cognition after OAB therapy with AC has produced conflicting results. β3a medication is has not been associated with dementia in clinical studies; however, higher neural effects are unknown.

Our multicenter, double blind, randomized, placebo-controlled trial uses functional magnetic resonance imaging (fMRI) and cognitive testing to evaluate the effects of AC and β3a on brain functional connectivity in females with non-neurogenic OAB.

Methods and Analysis

and analysis: Female patients with OAB symptoms ages 50–90 years old without baseline cognitive impairment, moderate to severe depression or anxiety, neurologic disorders, or significant incomplete bladder emptying are invited to participate. Subjects are randomized to one of three interventions for 29 ± 1 day: AC (Solifenacin succinate, Teva), β3a (Mirabegron, Myrbetriq, Astellas), or placebo. Functional neuroimaging data at baseline and post-intervention will be analyzed accordingly. Clinical cognitive assessments will be compared from baseline to post-intervention.

Ethics

All qualifying patients are properly consented before enrolling in this study that has been approved by the Institutional Review Board of participating institutions.

Anticholinergic Drugs in Geriatric Psychopharmacology

Drugs with anticholinergic action are widely prescribed in the elderly population due to their potential clinical benefits. However, these benefits are limited by adverse effects which may be serious in particular circumstances. This review presents different aspects of the use of anticholinergics in old age with a focus in psychogeriatric patients. We critically review published data on benefits and disadvantages of anticholinergics, which are often controversial. Prevalence, pathophysiology and measurement methods of the anticholinergic action of drugs are discussed. We also present the most important drawbacks resulting from its use, including effects on cognition in healthy and cognitively impaired people, in aged schizophrenia patients, emergence of delirium and psychiatric symptoms, influence in functionality, hospitalization, institutionalization and mortality, and the potential benefits and limitations of their discontinuation. Finally, we suggest practical recommendations for the safe use of anticholinergics in clinical conditions affecting elderly patients, such as dementia, schizophrenia and acute hallucinatory episodes, depression, anxiety, Parkinson's disease, cardiovascular conditions and urinary incontinence.

The effect of anticholinergic burden on cognitive and daily living functions in patients with schizophrenia

OBJECTIVE

This study aimed to explore the association between medication-associated anticholinergic burden and cognitive and daily living functions in patients with schizophrenia.

METHODS

Sixty patients with schizophrenia were recruited. We used the Anticholinergic Drug Scale (ADS) for evaluating medication-associated anticholinergic burden. The MATRICS Consensus Cognitive Battery (MCCB) and the University of California San Diego Performance-based Skills Assessment (UPSA) were used for evaluating cognitive and daily living functions. To assess clinical symptoms, psychiatrists conducted interviews using the Positive and Negative Syndrome Scale and the Calgary Depression Scale for Schizophrenia.

RESULTS

Subjects were divided into low (n = 31) and high (n = 29) anticholinergic burden based on ADS scores of 3 or more. The "high ADS" group had poorer cognitive (composite MCCB score, p < 0.001) and daily living functions (total UPSA score, p = 0.001) than the "low ADS" group. Medication-associated anticholinergic burden was negatively correlated with cognitive functions (composite MCCB score, r = -0.512, p < 0.001) and daily living functions (total UPSA score, r = -0.355, p = 0.005). A regression analysis showed that anticholinergic burden significantly explained the decline in cognitive functions (composite MCCB score, R² = 0.262, p < 0.001) and daily living functions (total UPSA score, R² = 0.126, p = 0.005). Explanatory power was reduced after a covariate adjustment, but the effects of the composite MCCB score (p = 0.013) and of the transportation domain score of the UPSA (p = 0.048) remained significant.

CONCLUSIONS

Our analysis shows that anticholinergic burden reduces cognitive and daily living functions in patients with schizophrenia. A drug strategy with minimal anticholinergic burden may be helpful to patients if it does not adversely affect clinical symptoms.