title: Pharmacotherapy for Neurocognitive Disorders Based on the Hypothesis of Endogenous Appearance of Anticholinergic Activity.
abstract: We previously proposed the hypothesis of endogenous anticholinergic activity (AA) in Alzheimer's disease (AD). According to this hypothesis, the downregulation of acetylcholine seen in AD is associated with upregulation/hyperactivity of N-methyl-D-aspartate receptor (NMDAR). The hyperactivation of NMDAR then induces inflammation, which, in turn, causes AA to appear endogenously. Based on this hypothesis, we commented that cholinesterase inhibitors (ChEIs) are 'preventative' therapy for AD and NMDAR antagonists are the true 'treatment' for AD. We also noted that ChEIs, such as donepezil, could treat delirium. Moreover, we proposed measuring serum anticholinergic activity in patients, particularly AD patients, in out-of-hospital pharmacies to monitor the anticholinergic burden for targeted treatment.
authors.affiliation: Department of Psychiatry, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Misa
authors.initials: M
authors.lastname: Hosoi
authors.forename: Koji
authors.initials: K
authors.lastname: Hori
authors.forename: Kimiko
authors.initials: K
authors.lastname: Konishi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tani
authors.forename: Hiroi
authors.initials: H
authors.lastname: Tomioka
authors.forename: Yuka
authors.initials: Y
authors.lastname: Kitajima
authors.forename: Norihisa
authors.initials: N
authors.lastname: Akashi
authors.forename: Atsuko
authors.initials: A
authors.lastname: Inamoto
authors.forename: Kenzo
authors.initials: K
authors.lastname: Kurosawa
authors.forename: Hajime
authors.initials: H
authors.lastname: Yuda
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hanashi
authors.forename: Hiromi
authors.initials: H
authors.lastname: Ouchi
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Hachisu
mesh_terms: D000109:Acetylcholine / Q000378:metabolism; D018680:Cholinergic Antagonists / Q000378:metabolism*; D002800:Cholinesterase Inhibitors / Q000627:therapeutic use*; D003072:Cognition Disorders / Q000188:drug therapy* / Q000378:metabolism*; D003704:Dementia; D006801:Humans; D016194:Receptors, N-Methyl-D-Aspartate / Q000378:metabolism
chemical_list: D018680:Cholinergic Antagonists; D002800:Cholinesterase Inhibitors; D016194:Receptors, N-Methyl-D-Aspartate; D000109:Acetylcholine