Comorbid conditions in older adults, including Parkinson’s disease and type 2 diabetes, can also predispose to a decline in cognition and amplify the effects of DACEs on cognitive function 10. For instance, normal age-related declines in memory could increase with susceptibility to the potential cognitive side effects of DACEs 10. Recent evidence has also demonstrated that DACEs may impair cognitive performance as well as physical function in older adults 7– 9. It has been observed that the use of an anticholinergic drug, such as the antagonist scopolamine, administered to healthy volunteers resulted in impairment of memory function, similar to that seen in Alzheimer dementia 6. In the nucleus basalis, identified basal forebrain cholinergic neurons innervate the cerebral cortex, amygdaloid complex or hippocampus and are necessary for learning and memory formation 6. The neurotransmitter acetylcholine (ACh) is critical for communication between neurons and muscle at the neuromuscular junction for modulating posture and movement, direct neurotransmission in autonomic ganglia, and pathways in the brain that are involved in memory and cognitive function 5, 6. CNS effects include agitation, confusion, delirium, falls, hallucinations and cognitive dysfunction. Peripheral effects include constipation, dry mouth, dry eyes, tachycardia and urinary retention. The wide distribution of muscarinic acetylcholine receptor subtypes (M1–M5) in the central nervous system (CNS) and in the rest of the body largely accounts for the variety of peripheral and CNS adverse effects with DACEs 2– 4. Older adults have a relatively high probability of being exposed to DACEs due to their high medical comorbidity and the number of prescribed and over-the-counter medications 1. Drugs with anticholinergic effects (DACEs) are commonly prescribed for the management of different conditions such as depression, psychosis, Parkinson’s disease, muscle spasms, allergy, excessive gastric acid, nausea and vomiting, intestinal motility disorders, overactive bladder and chronic obstructive pulmonary disease 1.
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