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Anticholingeric Syndrome in Older Adults

Anticholinergic Syndrome in Older Adults: Pathogenesis and clinical findings Age-related physiological changes Authors: Jasmine Nguyen Reviewers: Anika Zaman Luiza Radu, Taylor Wong* *MD at time of publication ↑ Degree of disease comorbidity in older adults ↑ Likelihood of polypharmacy and medication interactions ↓ Ability of the kidneys to excrete (↓ glomerular filtration rate) ↓ Ability of the liver to metabolize drugs effectively Breakdown of the blood- brain barrier Relative cholinergic deficit compared to younger adults Use of anticholinergic medication(s) (e.g. antihistamines, antipsychotics, antidepressants, urinary incontinence medications) Higher anticholinergic burden in older adults Anticholinergic Syndrome Sequelae of symptoms following accidental or intentional overdose of compound(s) with anticholinergic activity Anticholinergic drug competitively binds against acetylcholine at muscarinic cholinergic receptors Inhibition of peripheral muscarinic cholinergic receptors Inhibition of muscarinic cholinergic receptors in the central nervous system Dysregulation of acetylcholine levels in the brain, which is responsible for memory, attention, learning, and arousal Cardiovascular: Sudoriferous glands: inability to produce or excrete sweat Gastro- intestinal: impaired gut motility Constipation Blurry vision Bladder: impaired detrusor muscle contraction & urethral Eyes: impaired pupillary contraction & ability to accommodate Inhibition of muscarinic- sensitive delayed rectifying potassium efflux channels on cardiomyocytes Impaired ability to slow heart rate & lower blood pressure Impaired thermoregulation Hyperthermia Compensatory cutaneous vasodilation to release heat Flushed skin Dry sphincter skin opening Urinary retention Urinary stasis allows for bacterial overgrowth Urinary tract infection Abnormal pupillary dilation (mydriasis) Hypertension Delayed cardiomyocyte repolarization Prolonged QT interval in cardiac cycle (on ECG) Seizures Tachycardia Inattention Agitation/ Aggression Delirium develops Coma Fluctuating cognition Visual Hallucinations Legend: Pathophysiology Mechanism Sign/Symptom/Lab Finding Complications Published Nov 11, 2024 on www.thecalgaryguide.com