People with schizophrenia often experience problems with learning, memory, attention, and social cognition. A study published in AJP in Advance examines how the cumulative effects of medications with anticholinergic properties (decrease the activity of the neurotransmitter acetylcholine) may contribute to worse cognitive outcomes.
“Psychotropic medications, especially antipsychotics, are critically important therapeutics for schizophrenia, have substantially improved the lives and outcomes for countless patients living with schizophrenia, and represent an essential staple of comprehensive treatment,” wrote Yash Joshi, M.D., Ph.D., of the University of California, San Diego, and colleagues. However, “[e]fforts to limit or avoid excessive anticholinergic medication burden—regardless of source—may have a beneficial impact on cognitive outcomes in schizophrenia.”
Joshi and colleagues analyzed medication records of 1,120 adults with schizophrenia or schizoaffective disorder who were part of a study on the genetics of schizophrenia. The researchers assigned each medication that a patient was taking a score of 0 to 3 based on its anticholinergic strength (clozapine and olanzapine received 3s, for example, whereas risperidone received a 1). Most scores were available on an existing database known as the Anticholinergic Cognitive Burden (ACB) scale, and the researchers estimated scores for other medications based on their similarities to medications with ACB scores. The researchers added these scores together for total ACB score.
The average ACB score for the sample was 3.8, with individual scores ranging from 0 to 20. “For context, an ACB score of 3 in healthy older adults is associated with cognitive dysfunction and a 50% increase in risk for developing dementia,” Joshi and colleagues wrote. “In our data, the proportion of patients with an ACB score of at least 3 was 63%, with approximately 25% having an ACB score ≥6.”
Joshi and colleagues found that patients with higher ACB scores had on average lower scores on various cognitive assessments; deficits were seen across multiple cognitive domains including memory, attention, visual and spatial recognition, and motor skills. The connection between higher ACB score and worse cognitive function persisted even after adjusting for patients’ age, severity of illness, smoking status, and antipsychotic dose.
“The present results do not necessarily suggest that a specific psychotropic or combination of psychotropics is ‘better’ or ‘worse’ for cognition,” the authors wrote. However, physicians should be cognizant of a patient’s cumulative anticholinergic burden when prescribing both psychotropic as well as nonpsychotropic medications, they continued.
To learn more about this topic, see the Psychiatric News article “Anticholinergics Linked to Increased Risk of Dementia.”
(Image: iStock/AlexanderFord)
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