| Cardiac effect of cholinesterase inhibitors used in Alzheimer's disease--from basic research to bedside. | |
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MedLine Citation:
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PMID: 15975060 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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In this review, the basic mechanism of the parasympathetic nervous effect on the heart is discussed. This is expanded to clinical situations to clarify what can happen to patients after cholinesterase (ChE) inhibitor is administered and to avoid unnecessary adverse effects. The parasympathetic nervous system can affect heart as well as brain function, and its effect on the heart is more complicated than is generally thought. The best-known effect is the cardioinhibitory effect, i.e. slowing of the heart rate. Its effect is also very sensitive to the time at which the stimulus falls within the cardiac cycle (phase-dependent effect). On some occasions, a cardiostimulatory effect can be observed. The parasympathetic nervous system also interacts with the sympathetic nervous system (sympathetic-parasympathetic interaction). ChE inhibitors or acetylcholinesterase inhibitors are often being administered to improve cognitive function of patients with Alzheimer's disease. The heart is naturally rich with ChE, and its inhibition may affect cardiac function, especially in elderly patients, many of whom have concomitant cardiovascular disease. Inhibition of ChE retards ACh degradation and potentiates the cardioinhibitory effect. However, the effect of ChE inhibitor is only slight in patients that receive a typical dose. After administration of ChE inhibitor in humans, the phase-dependent effect is reduced because the parasympathetic nervous effect is potentiated and saturated (saturation mechanism). Beat-by-beat fluctuation is reduced. ChE inhibitor increases arterial blood pressure through central M1 and M2 subtypes of muscarinic receptors (Br J Pharmacol 127:1657-1665, 1999). However, diastolic blood pressure increases slightly. |
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Authors:
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Yukitaka Masuda |
Publication Detail:
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Type: Journal Article; Review |
Journal Detail:
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Title: Current Alzheimer research Volume: 1 ISSN: 1567-2050 ISO Abbreviation: - Publication Date: 2004 Nov |
Date Detail:
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Created Date: 2005-06-24 Completed Date: 2005-07-21 Revised Date: 2005-11-16 |
Medline Journal Info:
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Nlm Unique ID: 101208441 Medline TA: Curr Alzheimer Res Country: United Arab Emirates |
Other Details:
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Languages: eng Pagination: 315-21 Citation Subset: IM |
Affiliation:
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Neurocardiology Unit, Department of Medicine, Tashirodai Hospital, Mitou, Yamaguchi 754-0122, Japan. yuknrepi@c-able.ne.jp |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Alzheimer Disease
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drug therapy* Animals Biomedical Research Cholinesterase Inhibitors / adverse effects, therapeutic use* Diffusion of Innovation Heart / drug effects* Humans |
| Chemical | |
Reg. No./Substance:
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0/Cholinesterase Inhibitors |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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