Anticholinergics and Cholinesterase Inhibitors

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Anticholinergic medications used to treat motor symptoms in PD potentially produce adverse effects on memory, executive functions, and global cognitive abilities. In placebo-controlled studies, Bedard et al. (114,115) found anticholinergics to induce executive deficits in PD, but not in control participants. Although anticholinergic-induced memory decrements are observable even in patients without preexisting cognitive impairments (116), Saint-Cyr (117) found that confusional states are more likely to be induced by anticholinergics in patients with preexisting cognitive impairment. Thus, anticholinergics should be avoided in elderly patients who are susceptible to developing confusional states (118).

Cholinesterase inhibitors were initially used sparingly and rarely in PDD and LBD. There is increasing recognition that cholinesterase inhibitors such as rivastig-mine, donepezil, and galantamine may improve not only cognition, but also neu-ropsychiatric symptoms in both conditions, and that these agents are well tolerated by patients with PD (119-123).

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