Skip to main content
Journal of Neurology, Neurosurgery, and Psychiatry logoLink to Journal of Neurology, Neurosurgery, and Psychiatry
. 1982 Dec;45(12):1161–1164. doi: 10.1136/jnnp.45.12.1161

Confusion, dementia and anticholinergics in Parkinson's disease.

Y de Smet, M Ruberg, M Serdaru, B Dubois, F Lhermitte, Y Agid
PMCID: PMC491705  PMID: 7161613

Abstract

Among a population of 75 hospitalised Parkinsonian subjects, confusional states were observed in 46% of demented patients not receiving anticholinergic drugs and in 93% of demented patients under anticholinergic therapy. The sensitivity of demented Parkinsonians to anticholinergic drugs can be attributed to a cholinergic deficiency which has been detected in the cortex and hippocampus of Parkinsonian patients post-mortem. The observations suggest that anticholinergic medication should be avoided in Parkinsonians with intellectual impairment.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Albert M. L., Feldman R. G., Willis A. L. The 'subcortical dementia' of progressive supranuclear palsy. J Neurol Neurosurg Psychiatry. 1974 Feb;37(2):121–130. doi: 10.1136/jnnp.37.2.121. [DOI] [PMC free article] [PubMed] [Google Scholar]
  2. Beardsley J. V., Puletti F. Personality (MMPI) and cognitive (WAIS) changes after levodopa treatment. Arch Neurol. 1971 Aug;25(2):145–150. doi: 10.1001/archneur.1971.00490020063007. [DOI] [PubMed] [Google Scholar]
  3. Boller F., Mizutani T., Roessmann U., Gambetti P. Parkinson disease, dementia, and Alzheimer disease: clinicopathological correlations. Ann Neurol. 1980 Apr;7(4):329–335. doi: 10.1002/ana.410070408. [DOI] [PubMed] [Google Scholar]
  4. Bowen F. P., Kamienny R. S., Burns M. M., Yahr M. Parkinsonism: effects of levodopa treatment on concept formation. Neurology. 1975 Aug;25(8):701–704. doi: 10.1212/wnl.25.8.701. [DOI] [PubMed] [Google Scholar]
  5. Celesia G. G., Wanamaker W. M. Psychiatric disturbances in Parkinson's disease. Dis Nerv Syst. 1972 Sep;33(9):577–583. [PubMed] [Google Scholar]
  6. Cotzias G. C., Papavasiliou P. S., Gellene R. Modification of Parkinsonism--chronic treatment with L-dopa. N Engl J Med. 1969 Feb 13;280(7):337–345. doi: 10.1056/NEJM196902132800701. [DOI] [PubMed] [Google Scholar]
  7. DOSHAY L. J., CONSTABLE K., ZIER A. Five year follow-up of treatment with trihexyphenidyl (artane); outcome in four hundred eleven cases of paralysis agitans. J Am Med Assoc. 1954 Apr 17;154(16):1334–1336. doi: 10.1001/jama.1954.02940500014005. [DOI] [PubMed] [Google Scholar]
  8. Davies P. Neurotransmitter-related enzymes in senile dementia of the Alzheimer type. Brain Res. 1979 Aug 3;171(2):319–327. doi: 10.1016/0006-8993(79)90336-6. [DOI] [PubMed] [Google Scholar]
  9. Drachman D. A., Stahl S. Letter: Extrapyramidal dementia and levodopa. Lancet. 1975 Apr 5;1(7910):809–809. doi: 10.1016/s0140-6736(75)92479-4. [DOI] [PubMed] [Google Scholar]
  10. Duvoisin R. C., Katz R. Reversal of central anticholinergic syndrome in man by physostigmine. JAMA. 1968 Nov 25;206(9):1963–1965. [PubMed] [Google Scholar]
  11. Hakim A. M., Mathieson G. Dementia in Parkinson disease: a neuropathologic study. Neurology. 1979 Sep;29(9 Pt 1):1209–1214. doi: 10.1212/wnl.29.9_part_1.1209. [DOI] [PubMed] [Google Scholar]
  12. Javoy-Agid F., Agid Y. Is the mesocortical dopaminergic system involved in Parkinson disease? Neurology. 1980 Dec;30(12):1326–1330. doi: 10.1212/wnl.30.12.1326. [DOI] [PubMed] [Google Scholar]
  13. Javoy-Agid F., Ruberg M., Taquet H., Studler J. M., Garbarg M., Llorens C., Schwartz J. C., Grouselle D., Lloyd K. G., Raisman R. Biochemical neuroanatomy of the human substantia nigra (pars compacta) in normal and Parkinsonian subjects. Adv Neurol. 1982;35:151–163. [PubMed] [Google Scholar]
  14. LEVITA E., RIKLAN M., COOPER I. S. COGNITIVE AND PERCEPTUAL PERFORMANCE IN PARKINSONISM AS A FUNCTION OF AGE AND NEUROLOGICAL IMPAIRMENT. J Nerv Ment Dis. 1964 Dec;139:516–520. doi: 10.1097/00005053-196412000-00003. [DOI] [PubMed] [Google Scholar]
  15. Lieberman A., Dziatolowski M., Kupersmith M., Serby M., Goodgold A., Korein J., Goldstein M. Dementia in Parkinson Disease. Ann Neurol. 1979 Oct;6(4):355–359. doi: 10.1002/ana.410060409. [DOI] [PubMed] [Google Scholar]
  16. Loranger A. W., Goodell H., Lee J. E., McDowell F. Levodopa treatment of Parkinson's syndrome. Improved intellectual functioning. Arch Gen Psychiatry. 1972 Feb;26(2):163–168. doi: 10.1001/archpsyc.1972.01750200067014. [DOI] [PubMed] [Google Scholar]
  17. Loranger A. W., Goodell H., McDowell F. H., Lee J. E., Sweet R. D. Intellectual impairment in Parkinson's syndrome. Brain. 1972;95(2):405–412. doi: 10.1093/brain/95.2.405. [DOI] [PubMed] [Google Scholar]
  18. Marsh G. G., Markham C. M., Ansel R. Levodopa's awakening effect on patients with Parkinsonism. J Neurol Neurosurg Psychiatry. 1971 Jun;34(3):209–218. doi: 10.1136/jnnp.34.3.209. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Marttila R. J., Rinne U. K. Dementia in Parkinson's disease. Acta Neurol Scand. 1976 Nov;54(5):431–441. doi: 10.1111/j.1600-0404.1976.tb04375.x. [DOI] [PubMed] [Google Scholar]
  20. Mayeux R., Stern Y., Rosen J., Leventhal J. Depression, intellectual impairment, and Parkinson disease. Neurology. 1981 Jun;31(6):645–650. doi: 10.1212/wnl.31.6.645. [DOI] [PubMed] [Google Scholar]
  21. Mindham R. H. Psychiatric symptoms in Parkinsonism. J Neurol Neurosurg Psychiatry. 1970 Apr;33(2):188–191. doi: 10.1136/jnnp.33.2.188. [DOI] [PMC free article] [PubMed] [Google Scholar]
  22. Mortimer J. A., Pirozzolo F. J., Hansch E. C., Webster D. D. Relationship of motor symptoms to intellectual deficits in Parkinson disease. Neurology. 1982 Feb;32(2):133–137. doi: 10.1212/wnl.32.2.133. [DOI] [PubMed] [Google Scholar]
  23. Pollock M., Hornabrook R. W. The prevalence, natural history and dementia of Parkinson's disease. Brain. 1966 Sep;89(3):429–448. doi: 10.1093/brain/89.3.429. [DOI] [PubMed] [Google Scholar]
  24. Reisine T. D., Yamamura H. I., Bird E. D., Spokes E., Enna S. J. Pre- and postsynaptic neurochemical alterations in Alzheimer's disease. Brain Res. 1978 Dec 29;159(2):477–481. doi: 10.1016/0006-8993(78)90562-0. [DOI] [PubMed] [Google Scholar]
  25. Rossor M., Fahrenkrug J., Emson P., Mountjoy C., Iversen L., Roth M. Reduced cortical choline acetyltransferase activity in senile dementia of Alzheimer type is not accompanied by changes in vasoactive intestinal polypeptide. Brain Res. 1980 Nov 10;201(1):249–253. doi: 10.1016/0006-8993(80)90795-7. [DOI] [PubMed] [Google Scholar]
  26. Ruberg M., Ploska A., Javoy-Agid F., Agid Y. Muscarinic binding and choline acetyltransferase activity in Parkinsonian subjects with reference to dementia. Brain Res. 1982 Jan 28;232(1):129–139. doi: 10.1016/0006-8993(82)90615-1. [DOI] [PubMed] [Google Scholar]
  27. Selby G. Cerebral atrophy in Parkinsonism. J Neurol Sci. 1968 May-Jun;6(3):517–559. doi: 10.1016/0022-510x(68)90034-8. [DOI] [PubMed] [Google Scholar]
  28. Stephens D. A. Psychotoxic effects of benzhexol hydrochloride (Artane). Br J Psychiatry. 1967 Feb;113(495):213–218. doi: 10.1192/bjp.113.495.213. [DOI] [PubMed] [Google Scholar]
  29. Whitehouse P. J., Price D. L., Clark A. W., Coyle J. T., DeLong M. R. Alzheimer disease: evidence for selective loss of cholinergic neurons in the nucleus basalis. Ann Neurol. 1981 Aug;10(2):122–126. doi: 10.1002/ana.410100203. [DOI] [PubMed] [Google Scholar]

Articles from Journal of Neurology, Neurosurgery, and Psychiatry are provided here courtesy of BMJ Publishing Group

RESOURCES