Objectives

Physicians have prescribed anticholinergic agents as monotherapy or adjuvant therapy in patients with Parkinson’s disease for decades. However, these medications can cause many adverse effects including gait freezing and falling. Herein we assessed the effects of anticholinergic medications on motor function, freezing of gait and falling in a group of patients with PD.

Patients and Methods

This prospective study evaluated the effect of gradual discontinuation of anticholinergics on motor function in 131 outpatients with Parkinson’s disease. We assessed patients’ motor function at baseline six and twelve months later using the UPDRS-III. We also evaluated freezing of gait and falling in patients using UPDRS-II part 14 and 13 respectively. The anticholinergics were tapered and gradually discontinued and additional levodopa doses were added as patients needed.

Results

131patients successfully discontinued their anticholinergic medications. Stopping anticholinergics significantly improved the motor symptoms in PD patients as reflected in the change between the mean (±SD) UPDRS-III score of 36.85(±11.5) at the baseline to 32.51(±11.4) and 31.43 (±11.3) after six and twelve months (P < 0.001). The mean (±SD) scores of freezing of gait (FOG)significantly changed from 1.34(±1) to 1.17(±1) and 0.6(±0.7) and for falling down from 0.62(±0.8) to 0.5 (±0.8) and 0.29(±0.5) respectively (p-value of <0.001).

Conclusion

Our finding demonstrated an improvement in motor function and FOG and falling incidences in PD patients, after discontinuation of anticholinergic drugs. As motor complications adversely affect the quality of life in PD patients, clinicians must be careful with the unnecessary use of anticholinergic drugs in their treatment strategies.

中文翻译：

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抗胆碱能药物停药对帕金森病患者运动功能的影响

目标

几十年来，医生将抗胆碱能药物作为单一疗法或辅助疗法用于帕金森病患者。然而，这些药物会导致许多不良反应，包括步态冻结和跌倒。在此，我们评估了抗胆碱能药物对一组 PD 患者的运动功能、步态冻结和跌倒的影响。

患者和方法

这项前瞻性研究评估了逐渐停用抗胆碱能药物对 131 名帕金森病门诊患者运动功能的影响。我们在 6 个月和 12 个月后使用 UPDRS-III 评估了基线时患者的运动功能。我们还分别使用 UPDRS-II 第 14 部分和第 13 部分评估了患者步态冻结和跌倒的情况。抗胆碱能药逐渐减量并逐渐停用，并根据患者需要增加额外的左旋多巴剂量。

结果

131 名患者成功停用抗胆碱能药物。停用抗胆碱能药物显着改善了 PD 患者的运动症状，这反映在基线时平均 (±SD) UPDRS-III 评分从 36.85(±11.5) 到 6 和 32.51(±11.4) 和 31.43 (±11.3) 之间的变化。十二个月（P < 0.001）。步态冻结（FOG）的平均（±SD）得分从1.34（±1）显着变化到1.17（±1）和0.6（±0.7），从0.62（±0.8）下降到0.5（±0.8）和 0.29(±0.5)（p 值 <0.001）。

结论

我们的发现表明，在停用抗胆碱能药物后，PD 患者的运动功能和 FOG 以及跌倒发生率都有所改善。由于运动并发症对 PD 患者的生活质量产生不利影响，临床医生在治疗策略中必须小心避免不必要地使用抗胆碱能药物。