title: Demonstrating the Role of Anticholinergic Activity in a Mood Disorder.
abstract: We report a case of a 54-year-old woman presenting with amnesia, apathy, work-related difficulties and mental stress. At presentation, her Mini-Mental State Examination score was 27 and her serum anticholinergic activity (SAA) was positive without medication or recent physical illnesses. In addition, magnetic resonance imaging revealed mild atrophy of the frontal and temporal lobes, with a relatively intact hippocampus. Consequently, we diagnosed mild cognitive impairment due to Alzheimer's disease and prescribed a cholinesterase inhibitor (donepezil, 10 mg/day); her SAA fully disappeared and clinical symptoms partially resolved. Addition of duloxetine coupled with environmental adjustments caused her cognitive function to return to a normal level, so we diagnosed pseudodementia due to depression. In this case, we believe that the simultaneous cholinergic burden and mental stress led to positive SAA, which made it reasonable to prescribe a cholinesterase inhibitor to ameliorate the associated acetylcholine hypoactivity. We believe that it is essential to recognize the importance of prescribing a cholinesterase inhibitor for specific patients, even those with pseudodementia, to control their clinical symptoms. Moreover, SAA might be a useful biomarker for identifying this subgroup of patients. We propose that anticholinergic activity appears endogenously in mood disorders (depression and bipolar disorder) and set out our rationalization for this hypothesis.
authors.affiliation: Department of Psychiatry, Showa University Northern Yokohama Hospital, Yokohama, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Hori
authors.forename: Kimiko
authors.initials: K
authors.lastname: Konishi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Hanashi
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: Sayaka
authors.initials: S
authors.lastname: Hasegawa
authors.forename: Takuji
authors.initials: T
authors.lastname: Izuno
authors.forename: Nodoka
authors.initials: N
authors.lastname: Kikuchi
authors.forename: Misa
authors.initials: M
authors.lastname: Hosoi
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Hachisu
mesh_terms: D000647:Amnesia / Q000150:complications; D018680:Cholinergic Antagonists / Q000097:blood* / Q000627:therapeutic use*; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008875:Middle Aged; D019964:Mood Disorders / Q000097:blood* / Q000188:drug therapy* / Q000209:etiology
chemical_list: D018680:Cholinergic Antagonists