Possible muscarinic supersensitivity in Alzheimer's disease

In contrast to the well established presynaptic cholinergic deficits which are associated with Alzheimer's Disease (AD), the functional status of the remaining muscarinic receptors has not received adequate attention. This paper examined the possibility that the presynaptic cholinergic deficits in AD may be accompanied by muscarinic supersensitivity. While the majority of QNB binding studies have failed to find an upregulation of muscarinic receptors in AD patients, most of those studies did not differentiate between presynaptic and postsynaptic receptors. In addition, receptor density and functional response are not necessarily correlated. To determine whether AD is accompanied by alterations in the functional status of central muscarinic receptors, we studied the biological responses to a muscarinic agonist in AD patients and controls. In this pilot study, AD patients demonstrated an increased arecoline-induced HVA response in the CSF. This finding is consistent with the hypothesis that AD is accompanied by muscarinic supersensitivity.