(Press-News.org) Writing in the May 14, 2021 issue of The American Journal of Psychiatry, a multi-institution team of scientists led by researchers at University of California San Diego School of Medicine report that medications commonly prescribed to reduce the severity of physical and mental health symptoms associated with schizophrenia may have a cumulative effect of worsening cognitive function in patients.
Psychotropic medications are often necessary and beneficial, but they possess other secondary properties that are not directly related to reducing symptoms, including anticholinergic properties. That is, apart from their actual intended effects, they also inhibit acetylcholine, a neurotransmitter that is important in brain signaling and in a number of other body functions. Apart from schizophrenia, which is estimated to affect roughly 1.5 million Americans, drugs with anticholinergic properties are used to treat a wide variety of conditions, including urinary incontinence, chronic obstructive pulmonary disorder and some muscle disorders.
"Many medications have anticholinergic effects, and we are becoming increasingly aware about their potential long-term risks," said lead study author Yash Joshi, MD, assistant professor in the Department of Psychiatry at UC San Diego School of Medicine.
In fact, anticholinergic drugs have been linked to cognitive impairment and increased dementia risk in healthy adults. For example, a 2020 study by UC San Diego School of Medicine researchers found an association between anticholinergic medications and increased risk of Alzheimer's disease. Another study cited by authors reported that taking just one strong anticholinergic medication for three years was associated with a 50 percent increase in the odds of developing dementia over the 11-year study period.
Persons living with schizophrenia commonly experience significant difficulties with attention, learning, memory, executive function (such as reasoning and planning) and social cognition. Since these mental processes are critical for many daily activities, cognitive impairment in schizophrenia can lead to significant disability.
In the latest study, Joshi and colleagues sought to comprehensively characterize how the cumulative anticholinergic burden from different classes of medications impact cognition in patients with schizophrenia.
"We wanted to better understand how anticholinergic medication burden impacted cognitive functioning in individuals who may have already some cognitive difficulties due to schizophrenia," he said.
Researchers assessed medical records, including prescribed medications, of 1,120 study participants with schizophrenia. They found that 63 percent of participants had an anticholinergic cognitive burden (ACB) score of at least 3.
"This is striking because previous studies have shown that an ACB score of 3 in a healthy, older adult is associated with cognitive dysfunction and a 50 percent increased risk for developing dementia," said Joshi.
Notably, roughly one-quarter of the schizophrenia patients in the study had ACB scores of 6 or more.
The authors wrote that while such numbers may be high for persons living without any psychiatric illness, they are not difficult to achieve in patients receiving routine psychiatric care, which often includes medications with anticholinergic properties. For example, a patient prescribed daily olanzapine for symptoms of psychosis already starts with an ACB score of 3; add hydroxyzine for anxiety and insomnia in the same patient and their ACB score doubles. Many patients with schizophrenia are treated with multiple psychotropic drugs -- other medications for other health conditions could increase this burden further.
"It is easy even for well-meaning clinicians to inadvertently contribute to anticholinergic medication burden through routine and appropriate care," said Gregory Light, PhD, professor of psychiatry and senior author. "The unique finding here is that this burden comes from medications we don't usually think of as typical anticholinergic agents."
The authors said ACB should be considered when physicians prescribe medications for patients with schizophrenia, noting that emerging data suggests reducing anticholinergic burden is associated not only with cognitive benefit, but an improved quality of life.
"Brain health in schizophrenia is a game of inches, and even small negative effects on cognitive functioning through anticholinergic medication burden may have large impacts on patients' lives," said Joshi.
"Everyone caring for those living with schizophrenia -- mental health providers, primary care providers, specialists, and loved ones -- should be vigilant in trying to reduce anticholinergic burden in a holistic way so that we can be good stewards of our patients' long-term cognitive health. If clinically feasible and safe, this could include reducing the number of psychotropic medications, changing some psychotropic medications to others with lower anticholinergic properties, or using complementary approaches to enhance cognitive functioning."
INFORMATION:
Co-authors include: David L. Braff, Neal Swerdlow, Tiffany A. Greenwood, Laura R. MacDonald, Juan L. Molina, John A. Nungaray, Joyce Sprock and Ming T. Tsuang, all at UC San Diego and/or VA San Diego Healthcare System; Michael L. Thomas, Colorado State University; Michael F. Green, Keith H. Nuechterlein and Catherine A. Sugar, all at UCLA; Ruben C. Gur, Raquel E. Gur and Bruce I. Turetsky, all at University of Pennsylvania; William S. Stone, Harvard Medical School and Beth Israel Deaconess Medical Center; Laura C. Lazzeroni, Stanford University; Allen D. Radant and Debby W. Tsuang, both at University of Washington and VA Puget Sound Health Care System; Jeremy M. Silverman, Icahn School of Medicine at Mount Sinai and James J. Peters VA Medical Center.
Disclosure: Gregory Light has served as a consultant for Astellas, Heptares Therapeutics, Neurocrine, NeuroSig and Novartis.
CORVALLIS, Ore. - Oregon State University researchers say "topographic templates" can help forest conservation managers develop strategies for protecting and restoring the most fire-resistant parts of vulnerable forests across a range of ecosystems.
That's important because changing wildfire regimes are affecting forests around the globe, the scientists note, and areas that burn over and over in relatively quick succession may not be able to recover between fires.
"Fire refugia" - areas that burn less frequently and/or less severely than the landscape around them - are crucial for supporting post-blaze ecosystem ...
The research teams at the University of Hong Kong led by Professor Xuechen LI from the Research Division for Chemistry and Department of Chemistry, and Professor Yu WANG from the Department of Pharmacology and Pharmacy, reported a synthetic biotherapeutics with promising anti-tumour, insulin sensitising and hepatoprotective activities in the Journal of the American Chemical Society.
Obesity is a global pandemic associated with a significantly reduced life expectancy, it also increases the risk of type 2 diabetes, hypertension, coronary heart disease, stroke, chronic kidney disease and cancer. Adiponectin, as a protein hormone and adipokine, regulates glucose levels and improve lipid metabolism, and is a major player in the ...
A team including Northwestern University astrophysicists has developed the most realistic, highest-resolution 3D simulation of star formation to date. The result is a visually stunning, mathematically-driven marvel that allows viewers to float around a colorful gas cloud in 3D space while watching twinkling stars emerge.
Called STARFORGE (Star Formation in Gaseous Environments), the computational framework is the first to simulate an entire gas cloud -- 100 times more massive than previously possible and full of vibrant colors -- where stars are born.
It also is the first simulation to simultaneously model star formation, evolution and dynamics while accounting for stellar feedback, including jets, radiation, wind and nearby supernovae activity. ...
The challenges that many women face in today's labour market are well documented, from lower employment rates than men to lower rates of pay. Previous studies have considered how the burden of family care, which often falls largely on women's shoulders, has contributed to this imbalance. However, few of these studies have considered why women are the ones to bear that care burden.
A new study, published in the KeAi journal China Economic Quarterly International, has used data from China to investigate the impact of the concept of gender roles on women's employment and earnings.
Study author, Chuanchuan Zhang, of China's Zhejiang University, explains: "Traditionally, studies on women's labour supply ...
Tsukuba, Japan - Aggression is common in many neuropsychiatric diseases, such as dementia, autism spectrum disorder, and schizophrenia. It causes many problems for patients and their families, but can be difficult to treat because little is known about what causes it. In a study published last month in Molecular Psychiatry, researchers from the University of Tsukuba revealed that variation in levels of interleukin 1β (IL-1β), a protein that mediates the inflammatory response, is associated with individual differences in aggressive behaviors in male mice.
In humans, levels ...
[Outline]
A research group led by Specially appointed professor, Dr. Tatsuo Suzuki of Shinshu University School of Medicine developed a new purification protocol for Postsynaptic density (PSD) lattice, a core structure of the PSD of excitatory synapses in the central nervous system. The components of the PSD lattice were identified by comprehensive shotgun mass spectrometry and categorized as either minimum essential component (MEC) or non-MEC proteins. Tubulin was found to be a major component of the MEC, with non-microtubule tubulin widely distributed on the purified PSD lattice. The presence of tubulin in and around PSDs was verified by post-embedding immuno-gold labeling ...
Postpartum psychosis is a devastating, but rare, mental health problem that affects women in the first few weeks after giving birth. Symptoms vary widely, and can include high mood (mania), depression, confusion, hallucinations and delusions.
Although the disorder affects only one in every 1,000 women who have a baby, it is much more common in mothers with a history of bipolar disorder or schizoaffective disorder (a condition which has symptoms of schizophrenia and bipolar disorder), or women who have suffered a previous episode of postpartum psychosis.
There are currently no biological markers that help to identify women who ...
A study using a mouse model of eccentric contraction (*1) has revealed that icing injured muscles delays muscle regeneration. The discovery was made by a research group including Associate Professor ARAKAWA Takamitsu and then PhD. Student KAWASHIMA Masato from Kobe University's Graduate School of Health Sciences, and Chiba Institute of Technology's Associate Professor KAWANISHI Noriaki et al. In addition, the researchers illuminated that this phenomenon may be related to pro-inflammatory macrophages' (*2, 3, 4) ability to infiltrate damaged cells. This research raises questions as to whether or not severe muscle injuries (such as torn muscles) should be ...
Robust data and genetic research are providing important evidence on a colony of wild African vervet monkeys that landed in Dania Beach more than 70 years ago and settled in a thick mangrove forest near the Fort Lauderdale-Hollywood International Airport in South Florida.
The non-native vervet monkey (Chlorocebus sabaeus) population living in this urban coastal region is well known and beloved among local residents and city officials; however, it is relatively unknown to primatologists. Despite wide public interest, there has been only one scientific study (early 1990s), suggesting that the monkeys escaped from a failed roadside zoo in the 1950s and 1970s. Until now, there was no confirmation about ...
Scientists from Hokkaido University have developed a rapid, efficient protocol for cross-coupling reactions, vastly expanding the pool of chemicals that can be used for the synthesis of useful organic compounds.
Chemical reactions are a vital process in the synthesis of products for a diversity of purposes. For the most part, these reactions are carried out in the liquid phase, by dissolving the reactants in a solvent. However, there are a significant number of chemicals that are partially or completely insoluble, and thus have not been used for synthesis. The starting materials required for the synthesis of many cutting-edge organic materials--such as organic semiconductors and luminescent materials--are often poorly soluble, leading to problems in solution-based synthesis. Therefore, ...
