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To the Editor:
Krupp et al.1 reported that, in patients with multiple sclerosis (MS), the ability to learn and recall (declarative memory) could be improved with anticholinesterase treatment (donepezil). However, 10 subjects (29%) in the placebo control group and six subjects (17%) in the donepezil group were reported to have been taking bladder medications, which we presume included anticholinergic agents.
We reported two patients who took the bladder medication tolterodine (Detrol) and developed an amnestic disorder which reversed upon discontinuation of the medication.2,3 One of these patients also had hallucinations while taking tolterodine, but this symptom resolved after starting donepezil.3 We posited that these patients’ declarative memory disorders and hallucinations might have been induced by a medication-induced (tolterodine-induced) reduction of cerebral acetylcholine.
Given the inflammatory nature of MS, there is also the possibility that the cerebral blood-brain barrier was more porous to these medications, possibly leading to an increased CNS penetration of these anticholinergic agents. The resulting increase in the brain concentration of anticholinergic agents …
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