Effects of Anticholinergic Burden on Verbal Memory Performance in First-Episode Psychosis.

Antipsychotics are widely used to treat first-episode psychosis but may have an anticholinergic burden, that is, a cumulative effect of medications that block the cholinergic system. Studies suggest that a high anticholinergic burden negatively affects memory in psychosis, where cognitive deficits, particularly those in verbal memory, are a core feature of the disease. The present study sought to replicate this in a large cohort of well-characterized first-episode psychosis patients. We expected that patients in the highest anticholinergic burden group would exhibit the poorest verbal memory compared to those with low anticholinergic burden and healthy controls at baseline (3 months following admission). We further hypothesized that over time, at month 12, patients’ verbal memory performance would improve but would remain inferior to controls. Patients (n  =  311; low anticholinergic burden [n  =  241] and high anticholinergic burden [n  =  70], defined by a Drug Burden Index cut-off of 1) and healthy controls (n  =  128) completed a clinical and neurocognitive battery including parts of the Wechsler Memory Scale at months 3 and 12. Cross-sectionally, using an analysis of variance, patients in the highest anticholinergic burden group had the poorest performance in verbal memory when compared to the other groups at month 3, F(2,430)  =  52.33, P < 0.001. Longitudinally, using a Generalized Estimating Equation model, the verbal memory performance of all groups improved over time. However, patients’ performance overall remained poorer than the controls. These findings highlight the importance of considering the anticholinergic burden when prescribing medications in the early stages of the disease.

抗精神病药物被广泛用于治疗首发精神病，但可能具有抗胆碱能负担，即阻断胆碱能系统的药物的累积效应。研究表明，高抗胆碱能负担对精神病患者的记忆有负面影响，而认知缺陷，尤其是言语记忆方面的缺陷，是该疾病的一个核心特征。本研究试图在一大群特征明确的首发精神病患者中重复这一结果。我们预计，在基线（入院后3个月）时，与抗胆碱能负担低的患者和健康对照组相比，抗胆碱能负担最高组的患者将表现出最差的言语记忆。我们还假设，随着时间推移，在第12个月时，患者的言语记忆表现会有所改善，但仍不如对照组。 患者（n = 311；低抗胆碱能负担[n = 241]和高抗胆碱能负担[n = 70]，由药物负担指数临界值为1界定）和健康对照组（n = 128）在第3个月和第12个月完成了包括韦氏记忆量表部分内容的临床和神经认知测试。 在横断面研究中，通过方差分析，在第3个月时，与其他组相比，抗胆碱能负担最高组的患者在言语记忆方面表现最差，F(2,430) = 52.33，P < 0.001。在纵向研究中，通过广义估计方程模型，所有组的言语记忆表现都随时间有所改善。然而，患者的总体表现仍然比对照组差。 这些发现强调了在疾病早期开药时考虑抗胆碱能负担的重要性。