title: Mini Review: Anticholinergic Activity as a Behavioral Pathology of Lewy Body Disease and Proposal of the Concept of "Anticholinergic Spectrum Disorders".
abstract: Given the relationship between anticholinergic activity (AA) and Alzheimer's disease (AD), we rereview our hypothesis of the endogenous appearance of AA in AD. Briefly, because acetylcholine (ACh) regulates not only cognitive function but also the inflammatory system, when ACh downregulation reaches a critical level, inflammation increases, triggering the appearance of cytokines with AA. Moreover, based on a case report of a patient with mild AD and slightly deteriorated ACh, we also speculate that AA can appear endogenously in Lewy body disease due to the dual action of the downregulation of ACh and hyperactivity of the hypothalamic-pituitary-adrenal axis. Based on these hypotheses, we consider AA to be a behavioral pathology of Lewy body disease. We also propose the concept of "anticholinergic spectrum disorders," which encompass a variety of conditions, including AD, Lewy body disease, and delirium. Finally, we suggest the prescription of cholinesterase inhibitors to patients in this spectrum of disorders to abolish AA by upregulating ACh.
authors.affiliation: Department of Neuropsychiatry, St. Marianna University, School of Medicine, Kanagawa, Japan; Department of Psychiatry, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
authors.forename: Koji
authors.identifier: 0000-0002-6312-5375
authors.initials: K
authors.lastname: Hori
authors.affiliation: Tokyo Metropolitan Tobu Medical Center for Persons with Developmental/Multiple Disabilities, Tokyo, Japan.
authors.forename: Kimiko
authors.identifier: 0000-0002-8568-2228
authors.initials: K
authors.lastname: Konishi
authors.affiliation: Department of Psychiatry, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
authors.forename: Misa
authors.identifier: 0000-0003-2527-3833
authors.initials: M
authors.lastname: Hosoi
authors.affiliation: Department of Psychiatry, Showa University Northern Yokohama Hospital, Kanagawa, Japan.
authors.forename: Hiroi
authors.initials: H
authors.lastname: Tomioka
authors.affiliation: Department of Psychiatry, Showa University East Hospital, Tokyo, Japan.
authors.forename: Masayuki
authors.identifier: 0000-0001-6848-2235
authors.initials: M
authors.lastname: Tani
authors.affiliation: Department of Anesthesiology, School of Medicine, Juntendo University, Tokyo, Japan.
authors.forename: Yuka
authors.identifier: 0000-0002-3405-8353
authors.initials: Y
authors.lastname: Kitajima
authors.affiliation: Department of Pharmaceutical Therapeutics, Division of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo, Japan.
authors.forename: Mitsugu
authors.initials: M
authors.lastname: Hachisu