Disease Disability Research Articles

Anticholinergic burden and cognitive functions in schizophrenia: a systematic literature review

Abstract Background Cognitive dysfunction in schizophrenia forms the key cause of the disease's disability, leading in serious functional implications at the individual level and socioeconomic effects at global level. Dopaminergic-cholinergic balance is considered essential to cognitive function in schizophrenia while patients are often treated with many drugs with anticholinergic activity. This study aims to examine the association between high anticholinergic burden medication and cognitive function in schizophrenia patients. Methods A systematic review was performed on English language research studies published on PubMed from inception to December 2019 focusing on the effect of anticholinergic loads on cognitive domains in schizophrenia. No restrictions on study designs, age or geographical distribution were applied. Two researchers performed independently the screening and shortlisting of the eligible articles. A narrative synthesis of the main characteristics and the findings of included studies was reported. Results In total, fourteen articles of varying methodological design met the inclusion criteria. Three of them found significant improvement in cognition after anticholinergic discontinuation without adverse effects. Eleven studies found a significant association between high anticholinergic burden and cognitive impairment (e.g. verbal memory, information processing speed and working memory). However, the magnitude of the association in the largest study is statistically significant but of dubious clinical significance. Conclusions Medication with increased anticholinergic load has been found in most of the studies to affect the cognitive functions of people with schizophrenia. However, the lack of clinical and methodological homogeneity of selected studies, limit our interpretation and conclusions. Key messages There is some evidence indicating a negative effect of anticholinergic drug treatment on cognitive function of schizophrenia patients. Well-designed large prospective studies and randomized clinical trials are required to examine the effect of anticholinergic drug treatment in the cognition of schizophrenia patients.

Therapeutic potential of intravitreal pharmacotherapy in retinal vein occlusion.

Retinal vein occlusion (RVO) is the most common visually disabling disease affecting the retina after diabetic retinopathy. Although the disease entity has long been known, its management is still controversial. Macular edema is the main reason for decreased visual acuity (VA) in this retinal vascular disorder. Recently the vitreous cavity has increasingly been used as a reservoir of drugs for the direct treatment of macular edema through intravitreal injection route. The most widely injected drugs so far have been triamcinolone acetonide (TA) and bevacizumab. The objective of this review is to evaluate the evidence and discuss the rationale behind the recent suggestions that intravitreal pharmacotherapy by corticosteroids and anti-vascular endothelial growth factors may be useful in the treatment of retinal vein occlusion.

Present status of chemotherapy of bronchial cancer.

Nearly all patients with cancer of the bronchus sooner or later present problems in management of advanced and generalized neoplastic disease. So long as effective palliative agents (radiological and chemical) are at hand, these persons should never be regarded as “hopeless.” They are entitled to the same basic medical and humanitarian considerations as patients with other chronic and disabling diseases. Among the cancer-inhibiting drugs which have become clinically available in the past ten years, only the polyfunctional alkylating compounds seem to have any influence on primary lung cancer. This effect is non-specific, depending upon the remarkable affinity of these highly reactive compounds for any rapidly proliferating tissue. Nitrogen mustard (HN2) (methylbis betachloroethyl amine hydrochloride) was one of the first and remains one of the best of the mustard congeners to be utilized clinically by intravenous, intra-arterial and intrapleural routes. TEM (triethylene melamine), given orally, and Thiote...