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NEUROLOGY 1988;38:606
© 1988 American Academy of Neurology

No response to high-dose muscarinic agonist therapy in Alzheimer's disease

M. Maral Mouradian, MD, Erich Mohr, PhD, Jill A. Williams, MA and Thomas N. Chase, MD

From the Experimental Therapeutics Branch, National Institute of Neurological and Communicative Disorders and Stroke, Bethesda, MD.

Cholinergic deficiency is the most consistent transmitter system abnormality in Alzheimer's disease. To test the acute therapeutic efficacy of cholinergic replacement, seven patients with presenile onset of Alzheimer's type dementia received maximum tolerated doses (10 mg/d) of the selective muscarinic agonist, RS-86, in combination with a peripherally active anticholinergic glycopyrrolate (6 mg/d), in a double-blind placebo-controlled design. No consistent, clinically significant cognitive improvement could be discerned in these mild to moderately demented patients, despite attainment of central RS-86 levels approximating those that affect behavior in the experimental animal. Muscarinic agonist monotherapy may thus be inadequate to benefit Alzheimer's type dementia.

Address correspondence and reprint requests to Dr. Chase, ETB/NINCDS, Bldg 10, Rm 5C103, 9000 Rockville Pike, Bethesda, MD 20892.

Received July 24, 1987. Accepted for publication in final form August 7, 1987.




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