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Parkinson’s Disease
Volume 2016, Article ID 5380202, 7 pages
http://dx.doi.org/10.1155/2016/5380202
Review Article

Mini Review: Anticholinergic Activity as a Behavioral Pathology of Lewy Body Disease and Proposal of the Concept of “Anticholinergic Spectrum Disorders”

1Department of Neuropsychiatry, St. Marianna University, School of Medicine, Kanagawa, Japan
2Department of Psychiatry, Showa University Northern Yokohama Hospital, Kanagawa, Japan
3Tokyo Metropolitan Tobu Medical Center for Persons with Developmental/Multiple Disabilities, Tokyo, Japan
4Department of Psychiatry, Showa University East Hospital, Tokyo, Japan
5Department of Anesthesiology, School of Medicine, Juntendo University, Tokyo, Japan
6Department of Pharmaceutical Therapeutics, Division of Clinical Pharmacy, School of Pharmacy, Showa University, Tokyo, Japan

Received 7 May 2016; Accepted 26 July 2016

Academic Editor: Per Odin

Copyright © 2016 Koji Hori et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.