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Anticholinergic drugs: The stupid pills

MagazineApril 2009 (Vol. 20 Issue 1)Anticholinergic drugs: The stupid pills

Anticholinergic drugs, widely prescribed to the elderly for everything from incon-tinence to ulcers, can hasten an older person's decline

Anticholinergic drugs, widely prescribed to the elderly for everything from incon-tinence to ulcers, can hasten an older person's decline.

Recent studies carried out in the US found that nursing-home patients taking dementia and incontinence drugs at the same time had a 50-per-cent faster rate of physical decline compared with those taking only dementia drugs.

Anticholinergics work by blocking impulses in the parasympathetic nervous system, responsible for the involuntary actions of smooth muscle in many parts of the body. They also prevent the neurotransmitter acetyl-choline from binding with its receptors in nerve cells.

Three types of these drugs are used for problems such as ulcers, bladder spasm, heart arrhythmias, motion sickness, Parkinson's and control of blood pressure, and as muscle relax-ants or pre-anaesthetics. Perhaps the best-known examples of this drug family are Zantac (ranitidine) and nifedipine (Adalat, Procardia).

In this latest study, researchers examined 3536 nursing-home resi-dents, aged 65 and older, who were taking a bladder anticholinergic (oxy-butynin or tolterodine) for incon-tinence. They then carried out repeated analyses to assess the effects of the two drugs on cognitive function, and also examined any changes in daily activities. Around 10 per cent of the residents were taking both drugs.

They found that the combination of drugs most affected those who'd started out with higher levels of functioning in activities such as personal hygiene, dressing, bed mobility, eating and toileting. Among these residents, those given both drugs suffered a 50-per-cent greater decline in functionality compared with those given only cholinesterase inhibitors [for Alzheimer's (AD)].

Those given both drugs dropped 1.62 points per quarter on the scale for daily living function, while those given the single drug for AD declined 1.08 points. Those starting out with lower functionality had no further decline with both drugs compared with single therapy (J Am Geriatric Soc, 2008; 56: 847-53). However, the research-ers concluded that the tests they used were not sensitive enough to determine whether taking both drugs together increased mental decline.

Nevertheless, according to the study's lead author, Kaycee Sink, the decline was analogous to a nursing-home resident who initially required only limited assistance suddenly becoming completely dependent on others to help him perform his daily routine.

The researchers believe that the results may be due to an 'oppositional effect' between the two sorts of drugs. Dementia drugs such as donepezil (Aricept) and galantamine (Raza-dyne) increase acetylcholine, whereas the anticholinergics do just the opposite. The team concluded that such pharmacological opposites would cancel out the effectiveness of either or both drugs.

However, even on their own, anti-cholinergics may lead to functional decline. Older adults taking these drugs on their own for incontinence, high blood pressure or allergies are likely to suffer from impaired physical function.

This was shown in a study of 3000 seniors, 40 per cent of whom were taking anticholinergics. Patients who'd started out needing only limited assistance in a physical activity were entirely dependent on assistance one year later. These findings were pre-sented at the American Geriatrics Society meeting in Washington, DC, in May of this year. According to the researchers, these effects were seen even in older adults who had normal memory and cognitive abilities.

"The effect is essentially that of a three- to four-year increase in age," said Sink. "So someone who is 75 in our study and taking at least one mod-erately anticholinergic medication is at a similar functional level to a 78 to 79 year old."

Earlier studies suggested that drugs for incontinence may be associated with cognitive decline.

The most worrying aspect of these studies is the sheer number of elderly people whose decline is being hasten-ed by polypharmacy. Dementia and incontinence represent two of the most common conditions for which drugs are dispensed in nursing homes. According to Sink, nearly a third of all patients taking anticholinergics also take a drug for incontinence.

In this instance, Alzheimer's may not be all in the patient's head. With this class of drugs, a patient may be trading incontinence for incapacity.

Lynne McTaggart

Dementia - or side-effects?

- Loss of coordination

- Disorientation

- Agitation

- Confusion

- Short-term memory loss

- Inability to concentrate or maintain a train of thought

- Illogical thinking

- Incoherent speech

- Muscle jerks

- Visual and auditory hallucinations.

The power of the pulse

Alzheimer's and other forms of 'mental' illness have been found to respond extraordinarily well to tiny pulses of electromagnetic frequency.

Although the human body reacts badly to the sea of electrosmog all around us, some electromagnetic fields (EMFs) can be good for you. Indeed, it can be particularly good for your brain if delivered in rapid bursts of pulses.

Copious evidence from Greek and Italian researchers have demonstrated that tiny EM pulses can help memory loss, confusion and the general 'brain fog' of Alzheimer's disease (AD), and even more serious disorders such as schizophrenia.

These therapies rest on the theories of the late Jacques Benveniste, Dr Robert Becker and Cyril Smith, whose experimental evidence has decisively shown that cells of the body communi-cate with each other primarily through EM signalling at low frequencies (less than 20 kHz), rather than through chemistry.

On this basis, scientists now theorize that illness is the result when this communication system breaks down. However, outside frequencies can repair the damage.

It's known that the brain 'entrains' itself to outside stimulation. Copious evidence shows that, when the brain receives an auditory or visual stimulus of a specific frequency, the brain waves quickly begin to resonate at the same frequency. Many scientists now believe that sending cells low-level, alternating pulsed EMFs (PEMFs) 'reminds' them of the correct frequency and allows them to repair themselves.

Clinical application of PEMFs began with the repair of bones, mostly by US orthopaedic surgeon Dr C.A. (Andy) Bassett, who discovered that broken bones targeted by low-energy magnetic fields healed twice as fast as usual. After trial and error, it was found that the best results came with electrical energy in quick pulsating bursts.

However, scientists have recently moved on to using PEMFs at even lower frequencies ('picoTeslas') to treat mental illness, after finding that the brain waves of epileptics are abnormal in relation to a particular frequency.

Dr Reuven Sandyk, of The Carrick Institute for Clinical Ergonomics, Rehabilitation, & Applied Neurosci-ences School of Engineering Technol-ogies, State University of New York at Farmingdale, has pioneered work using tiny PEMFs in the picoTesla range (1 picoTesla = 10-6 microTesla) to reverse brain damage. His devices can produce a magnetic field ranging from 5 x 10-8 gauss to 2.5 x 10-7 gauss at frequencies of 2 to 7 Hz.

His earlier work used PEMFs to reverse the damage in patients with multiple sclerosis (MS) and Parkin-son's disease. These tiny pulses not only reduced the need for medication, but also appeared to reverse many of the mental problems associated with the two conditions. He also noticed that MS patients exposed to PEMFs improved their ability to recall dreams (Int J Neurosci, 1995; 82: 113-25) and mani-fested less suicidal behaviour (Int J Neurosci, 1996; 87: 5-15), while improving their cognitive ability (Int J Neurosci, 1997; 90: 59-74). Parkinson's patients not only showed improvement in visual ability (Int J Neurosci, 1995; 81: 47-65), speech (Int J Neurosci, 1997; 91: 57-68) and general cognitive ability (Int J Neurosci, 1997; 91: 57-6), but also in dual-tasking, such as walking and talking at the same time (Int J Neurosci, 1997; 92: 95-102).

As AD patients share many of the same mental impairments of those with Parkinson's, and many Parkin-son's patients have dementia, Dr Sandyk also experimented with PEMFs in patients with AD. He found that these tiny picoTesla pulses of EMFs helped to improve visual memory and other cognitive functions, such as short-term memory, mental calcula-tions, patient orientation, judgement and reasoning, social interactions and mood in such patients (Int J Neurosci, 1994; 76: 185-225).

Sandyk and others believe that the success of PEMFs may have to do with its effects on the pineal gland, the cone-shaped pea-sized gland that sits on the roof of the third ventricle of the brain, directly behind the root of the nose. Pineal dysfunction has been implicated in the cause of illnesses such as MS and AD. The PEMFs are aimed through the corpus callosum-the fissure running between the brain hemispheres-to have the greatest effect on the pineal gland.

In other research by J.I. Jacobson, another pioneer in this field, EMF stimulation was directly correlated with melatonin, which also resulted in the improvement or resolution of symptoms in most patients (Panminerva Med, 1994; 36: 201-5).

So far, the studies using PEMFs are relatively few, but the success of the pioneering work suggests that we should look further into the possibility that the pineal gland is not only involved in circadian rhythms, but also in keeping us mentally sharp.

Lynne McTaggart

The master switch

The pineal gland's true function is still somewhat of a mystery. Although doctors and biologists know that the gland produces melatonin, which governs our sleep-wake cycle, some believe that it may also be the body's master switch-a sort of neuroendocrine transducer-through which a neural signal with environmental information is converted into a chemical message. It also appears to play a part in regulating mental stability, as low levels of melatonin have been implicated in schizophrenia, autism and epilepsy.

However, the pineal gland also appears to sense and transmit electromagnetic and geomagnetic waves. Indeed, researcher J.I. Jacobson believes that the pineal gland is magnetosensitive and, as such, serves as a receptor of electromagnetic waves in biological systems.

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