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Attention deficit in Alzheimer's disease is not simulated by an anticholinergic/antihistaminergic drug and is distinct from deficits in healthy aging

Department of Neurology, Oregon Health Sciences University, Portland, OR (Drs. Oken, Kaye, and Howieson and Shirley S. Kishiyama)
Portland Veterans Affairs Medical Center, Portland, OR (Drs. Kaye and Howieson).

Objective.: To evaluate attention deficit in Alzheimer's disease (AD) and its relationship to attention deficits associated with aging and with medications altering alertness.

Methods.: Ten patients with probable AD, 10 healthy old controls, and 15 young controls performed a covert orienting of spatial attention task. Young controls performed the task an additional time after ingestion of diphenhydramine 1 mg/kg. Reaction times were obtained following valid, neutral, and invalid cues.

Results.: In all groups, the reaction times were shortest for the validly cued stimuli and longest for the invalidly cued stimuli. Additionally, the AD patients performed disproportionately worse following the invalid cue than did the control groups. Young controls given diphenhydramine had decreased subjective alertness, performed worse than they did before drug but better than the old controls or AD patients, and had no disproportionate impairment with the invalid cue.

Conclusions.: AD patients have disproportionate problems shifting spatial attention compared with age-matched controls. Impaired attentional performance in AD cannot be simulated in young subjects by ingestion of a combined antihistamine/anticholinergic agent at a dose sufficient to produce significant changes in alertness.

Address correspondence and reprint requests to Dr. Barry S. Oken, Department of Neurology, Oregon Health Sciences University, 3181 SW Sam Jackson Park Road, Portland, OR 97201.

Supported in part by grants from the National Institutes of Health (RO1 AG08714 and 1P30 AG08017) and the Department of Veteran Affairs.

Presented in part at the 45th annual meeting of the American Academy of Neurology, New York, NY, April 1993.

Received July 29, 1993. Accepted for publication in final form September 16, 1993.

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