Impact of anticholinergic drugs withdrawal on motor function in patients with Parkinson's disease

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.

Automated summary

This study assessed the effects of discontinuing anticholinergic medications on motor function, freezing of gait, and falling in patients with Parkinson's disease. The results demonstrated significant improvements in motor symptoms, freezing of gait, and falling incidences after discontinuation of anticholinergic drugs, emphasizing the necessity for clinicians to carefully consider the use of these medications in treatment strategies for PD patients.