Medication use in patients presenting to a rural and remote memory clinic.

cortical activity through activation of muscarinic receptors. Brain regions containing cholinergic neurons include the nucleus basalis of Meynert (NBM) and the medial septal nuclei (MSN), which send diffuse projections to cortex.1-3 Brains of patients with Alzheimer’s Disease (AD) exhibit loss of cholinergic neurons in the NBM and MSN.4 These findings have lent considerable support to the cholinergic hypothesis of cognitive dysfunction.5 Acetylcholinesterase inhibitors such as donepezil,6 rivastigmine7 and galantamine8 are postulated to improve cognition by increasing cholinergic function. Patients with AD may be more sensitive to the effects of anticholinergic drugs than are age-matched controls.9 In addition, drugs with anticholinergic activities are relatively contraindicated in the elderly even in the absence of dementia.10-12 A significant number of drugs without prominent anticholinergic effects have also been shown to contribute to cognitive impairment in elderly patients.13 Benzodiazepines, in particular, have been implicated as potentially problematic in older adults.10,11 Previous studies have suggested an association between benzodiazepine use and cognitive impairment.14,15 In addition, polypharmacy is of concern in the elderly due to the additive effects of medications. This paper describes medication use in patients presenting to a multidisciplinary rural and remote memory clinic. Demographics of patients referred, patterns of medication use, and proportion of patients presenting on anticholinergic medications and benzodiazepines are discussed. This study assesses the extent of anticholinergic medication use in AD patients versus patients without AD, examines the Mini-Mental State Exam (MMSE) scores of patients on anticholinergic medications and not on anticholinergic medications, and compares the present findings with those in the published literature.