Abstract
Drug-induced cognitive impairments, especially those caused by anticholinergic medications, are common in the elderly. These “drug reactions” range from mild confusional states to frank delirium. Even though the medical community is good at identifying medications with significant anticholinergic side effects, medications with less severe, but still disabling cognitive effects, or more importantly, medication combinations leading to a significant “anticholinergic load” are frequently undetected. The serum anticholinergic radioreceptor assay was developed 25 years ago to help elucidate these problems and measures serum activity of all anticholinergics present in human serum. In this assay, serum is compared against an internal standard of a known anticholinergic compound (atropine) and in competition for all muscarinic cholinergic receptors against a potent muscarinic receptor antagonist. This paper reviews the published literature using this assay. This method has been proven reliable, highly reproducible, and a potent predictor of a wide range of cognitive impairment in a wide range of clinical conditions. The implications of the findings as well as future research are discussed.
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