Confusion, dementia and anticholinergics in Parkinson's disease

Among a population of 75 hospitalised Parkinsonian subjects, confusional states were observed in 46% of demented patients not receiving anticholinergic drugs and in 93% of demented patients under anticholinergic therapy. The sensitivity of demented Parkinsonians to anticholinergic drugs can be attributed to a cholinergic deficiency which has been detected in the cortex and hippocampus of Parkinsonian patients post-mortem. The observations suggest that anticholinergic medication should be avoided in Parkinsonians with intellectual impairment.