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

Figure 5

When the ACh deterioration is small, a larger AA insert of HPA axis dysfunction is necessary for the appearance of AA. However, when the ACh deterioration is large, a small AA insert of HPA axis dysfunction is sufficient for the appearance of AA. Of course, when the ACh deterioration is at a critical level, AA appears without HPA axis dysfunction. However, if ACh is not deteriorated or overloaded, the intact ACh system can be upregulated and compensate for any other AA inserts. We refer to the conditions encompassed by this concept as “anticholinergic spectrum disorders,” which include AD, LBD, and delirium. AD and LBD are primary NCDs, whereas delirium is a secondary NCD. AA: anticholinergic activity, ACh: acetylcholine, AD: Alzheimer’s disease, HPA axis: hypothalamic-pituitary-adrenal axis, LBD: Lewy body disease, and NCD: neurocognitive disorder.