BACKGROUND Cholinesterase inhibitors are used to treat the symptoms of dementia and can theoretically cause bradycardia. Previous studies suggest that patients taking these medications have an increased risk of undergoing pacemaker insertion. Since these drugs have a marginal impact on patient outcomes, it might be preferable to change drug treatment rather than implant a pacemaker. This popula...

BACKGROUND Cholinesterase inhibitors are commonly prescribed to treat dementia, but their adverse effect profile has received little attention. These drugs can provoke symptomatic bradycardia and syncope, which may lead to permanent pacemaker insertion. Drug-induced syncope may also precipitate fall-related injuries, including hip fracture. METHODS In a population-based cohort study, we inves...

Mukadam et al. (2008) report cholinesterase inhibitors to be effective in treating delirium. This suggests that cholinesterase inhibitors have a broader spectrum of effect than the treatment of dementia alone. Acetylcholine itself interacts with various other neurotransmitters. Cancelli et al. (2004) report that a fall in acetylcholine levels, as occurs in dementia, could increase sensitivity t...

Mukadam et al. (2008) report cholinesterase inhibitors to be effective in treating delirium. This suggests that cholinesterase inhibitors have a broader spectrum of effect than the treatment of dementia alone. Acetylcholine itself interacts with various other neurotransmitters. Cancelli et al. (2004) report that a fall in acetylcholine levels, as occurs in dementia, could increase sensitivity t...

The British Association for Psychopharmacology (BAP) coordinated a meeting of experts to review and revise its first (2006) Guidelines for clinical practice with anti-dementia drugs. As before, levels of evidence were rated using accepted standards which were then translated into grades of recommendation A to D, with A having the strongest evidence base (from randomized controlled trials) and D...

Diisopropyl fluorophosphate (DFP) has been shown to be a remarkably potent inhibitor of the enzymatic hydrolysis of acetylcholine (1). As a result of a wide survey (2), inhibition by dialkyl fluorophosphates appears to be specific for certain esterases and lipases (kidney acid phosphatase was found to be inhibited by relatively high concentrations). Since the cholinesterase of mammalian brain a...

Mukadam et al. (2008) report cholinesterase inhibitors to be effective in treating delirium. This suggests that cholinesterase inhibitors have a broader spectrum of effect than the treatment of dementia alone. Acetylcholine itself interacts with various other neurotransmitters. Cancelli et al. (2004) report that a fall in acetylcholine levels, as occurs in dementia, could increase sensitivity t...

The cholinergic dysfunction in AD is not necessarily predominant (1,4,5) and responsivity to a cholinesterase inhibitor is not diagnostic for Alzheimer’s disease. Normal young people have improved on psychometric measures in memory and attention after physostigmine challenge (3). Additionally, postmortem neurochemical measures of cholinergic function in AD patients do not correlate with ante mo...

This article reviews the cholinergic changes in Parkinson's disease and dementia (PDD) and dementia with Lewy bodies (DLB), their potential clinical implications, and the available evidence for cholinesterase inhibitors in the treatment of PDD and DLB. Marked neuronal loss of cholinergic nuclei, reduced cholinergic markers in the neocortex, hippocampus, and selected thalamic nuclei, and recepto...