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PubMed2003

Cholinesterase inhibitors for dementia with Lewy bodies.

BACKGROUND: Dementia with Lewy bodies (DLB) was first described in 1983, and clinical diagnostic criteria were published in the early to mid 1990s. It has been suggested DLB may account for up to 15-25% of cases of dementia among people aged over 65, although autopsy suggests much lower rates. Characteristic symptoms are dementia, marked fluctuation of cognitive ability, early and persistent visual hallucinations and spontaneous motor features of Parkinsonism. Falls, syncope, transient disturbances of consciousness, neuroleptic sensitivity, and hallucinations in other modalities are also common. This combination of features can be difficult to manage as neuroleptics can make the Parkinsonian and cognitive symptoms worse. There is evidence to suggest that the cholinesterase inhibitors may be beneficial in this disorder; small case series indicate that cholinesterase inhibitors are safe, and will improve both cognitive deficits and neuropsychiatric symptoms in DLB. OBJECTIVES: To assess the use of cholinesterase inhibitors in DLB. SEARCH STRATEGY: The trials were identified from a search of the Specialized Register of the Cochrane Dementia and Cognitive Improvement Group on 25 February 2002 using the terms 'lewy body', 'Lewy bodies' and 'Lewy'. This register contains records from all major health care databases and trial databases and is updated regularly. SELECTION CRITERIA: Randomized, double-blind trials in which treatment with cholinesterase inhibitors was administered and compared with alternative interventions in patients with DLB are included. DATA COLLECTION AND ANALYSIS: Two reviewers (TP, RW) independently assessed quality of trials according to criteria described in the Cochrane Collaboration Handbook. Each drug was to be examined separately, and together as a group. We also analysed data by time to outcome measurement; short-term (up to one month), medium term (one month up to six months) and long term (Six months and longer). The primary outcome measures of interest are in the following areas: neuropsychiatric features. i.e. psychiatric symptoms and behavioural disturbances, cognitive function, activities of daily living, global assessments, quality of life, including maintaining role and social functioning, effect on carers, safety as measured by incidence of adverse events and side effects, acceptability of treatment as measured by withdrawal from trials, and by patient/carer assessment, institutionalization and death. MAIN RESULTS: There was one included trial (McKeith 2000f) of rivastigmine compared with placebo on 120 patients. Neuropsychiatric InventoryThe 10-item test found no significant difference between the two groups in change of scores from baseline using intention-to-treat (ITT) analysis at 20 weeks and last observation carried forward (LOCF) analysis. The treatment effect was statistically significant in favour of rivastigmine if only observed cases (OC) were analysed (WMD -6.94, 95% CI -11.59 to -2.29, P=0.003). There were similar results for the NPI-4, with only the OC analysis showing a significant superiority of rivastigmine to placebo at 20 weeks (WMD -3.75, 95%CI -6.62 to -0.88, P=0.01).MMSE:Analysis of these results showed no statistically significant difference between the two groups at 20 weeks.CGC-plus:Analysis of the proportion of patients who had no change or became worse found no statistically significant difference between the two groups at 20 weeks for the ITT, LOCK and OC analyses. Adverse Events:The placebo group experienced significantly fewer adverse events than the treatment group (54/59 vs 46/61,OR 3.52, 95%CI 1.19 to 10.43). However, using ITT analysis of 20-week data, there was no significant difference between the two groups when serious adverse events were considered. There were no significant differences in death rates between the two groups at 20 weeks.Drop-out Rates:Analysis of these results showed no difference between the two groups at 20 weeks using ITT analysis. REVIEWER'S CONCLUSIONS: Patients with dementia with Lewy bodies who suffer from behavioural disturbance oS CONCLUSIONS: Patients with dementia with Lewy bodies who suffer from behavioural disturbance or psychiatric problems may benefit from rivastigmine if they tolerate it, but the evidence is weak. Further trials using rivastigmine are needed, as are trials of other cholinesterase inhibitors in dementia with Lewy bodies.

Aged↗
PubMed1989

Occupational risk of decreased plasma cholinesterase among pesticide production workers in Taiwan.

To determine the influence of ventilation control and work practices on the health of workers potentially exposed to organophosphate and carbamate compounds, we examined a total of 989 employees from pesticide factories in Taiwan during 1986-1987. Each employee was examined by a physician, and a blood sample was drawn for plasma cholinesterase, complete blood count, and liver and renal function tests. Forty-one employees with medical conditions that might alter the plasma cholinesterase were excluded. Results showed that 43 of 515 production employees had decreased plasma cholinesterase as compared with four of 340 non-production employees. Production employees working under adequate ventilation control seemed to have a lower prevalence of decreased plasma cholinesterase than those under inadequate ventilation control, although the difference was not statistically significant (p = 0.242). There was a significant association between the level of housekeeping and work practices and the prevalence of decreased plasma cholinesterase (p = 0.022). We conclude that inadequate ventilation control and poor work practices may create a potential danger of pesticide poisoning among production employees in Taiwan and should be corrected immediately.

Chemical Industry↗
PubMedDate not supplied

Assay of cholinesterase using a pro-enhancer of the luminol-H2O2-horseradish peroxidase reaction.

2-Naphthyl acetate acts as a pro-enhancer of the luminol-H2O2-horseradish peroxidase reaction. Cholinesterase hydrolyses the bound acetyl group and produces 2-naphthol, and this compound is an enhancer of the chemiluminescent reaction. We studied the kinetics of chemiluminescent emission and the influence of 2-naphthyl acetate and cholinesterase enzyme concentrations. The cholinesterase concentration versus chemiluminescence intensity maximum was linear for cholinesterase between 0 and 181 microU/mL, with a detection limit of 8 microU/mL and a relative standard deviation of 9.5% (n = 3), for a sample containing 90.67 microU/mL of cholinesterase.

Cholinesterases↗
PubMedDate not supplied

Inhibition and recovery of maternal and fetal cholinesterase enzyme activity following a single cutaneous dose of methyl parathion and diazinon, alone and in combination, in pregnant rats.

Pregnant Sprague-Dawley rats (14-18 days of gestation) were treated with a single cutaneous subclinical dose(s) of 10 mg kg(-1) (15% of LD(50)) of methyl parathion (O,O-dimethyl O-4-nitrophenyl phosphorothioate) and 65 mg kg(-1) (15% of LD(50)) of diazinon (O,O)-diethyl O-2-isopropyl-6-methylpyrimidinyl phosphorothioate, and their combination. Animals were sacrificed at 1, 2, 4, 12, 24, 48, 72, and 96 h after dosing. Inhibition of maternal and fetal cholinesterase enzyme activity has been determined. Methyl parathion significantly inhibited maternal and fetal brain acetylcholinesterase (AChE) and plasma butyrylcholinesterase (BuChE) activity within 24 h after dosing. Diazinon and a mixture of methyl parathion and diazinon caused lesser inhibition compared with methyl parathion alone. Recovery of maternal and fetal brain AChE activity was in the order of diazinon > combination of diazinon and methyl parathion > methyl parathion 96 h after dosing. Although fetal plasma BuChE activity recovered to 100% of control within 96 h of application, maternal BuChE activity remained inhibited to 55% and 32% of control 96 h after application of methyl parathion and a mixture of methyl parathion and diazinon, respectively. Following a single dermal dose of methyl parathion, the activity of maternal liver BuChE was 63% of control 2 h after dosing, whereas inhibition of placental AChE or BuChE activity occurred 12 and 1 h following a single dose of methyl parathion, corresponding to activities of 63% and 54% of control, respectively. Diazinon, alone or in combination with methyl parathion, did not inhibit significantly the maternal liver BuChE or placental AChE and BuChE activity. The results suggest that dermal application of a single dose of methyl parathion and diazinon, alone or in combination, has an easy access into maternal and fetal tissues, resulting in inhibition of cholinesterase enzymes. The lower inhibitory effect of the combination of methyl parathion and diazinon might be due to competition of diazinon with methyl parathion for cytochrome P-450 enzymes, resulting in formation of the potent cholinesterase inhibitor methyl paraoxon. The faster recovery of fetal cholinesterase enzymes is attributed to the rapid de novo synthesis of cholinesterase fetal tissues compared with the mother.

Acetylcholinesterase↗
PubMed1996

Relationship between parathion and paraoxon toxicokinetics, lung metabolic activity, and cholinesterase inhibition in guinea pig and rabbit lungs.

Kinetic parameters of parathion and paraoxon uptake were determined in isolated and perfused rabbit and guinea pig lungs. They were related to organophosphate-induced lung cholinesterase inhibition. A single pass procedure was used to perfuse the lungs with an artificial medium perfusate containing paraoxon or parathion. The paraoxon and parathion concentrations were determined in the effluents collected at chosen intervals over an 18-min period beginning at the start of perfusion. Three inflowing concentrations (1 nmol/ml, 10 nmol/ml, and 20 nmol/ml) were tested in guinea pig lungs and one (10 nmol/ml) in rabbit lungs. Cholinesterase activity was determined at time 0 and at the end of the experiment. The lungs abundantly extracted paraoxon and parathion over the perfusion period. The extraction ratio was consistently greater in guinea pig than in rabbit lungs. The uptake velocity varied biexponentially in time, suggesting the existence of two compartments. Initial uptake velocities (A, B) and slopes (alpha and beta) were calculated for both compartments. In guinea pigs, A, B and A + B increased proportionally to the supply rate of paraoxon and parathion while a and b remained constant. No significant difference was observed between parathion and paraoxon uptake kinetics. Parameter B was the only one to differ significantly between the two species (rabbits: 8.19 +/- 1.53 for parathion and 6.85 +/- 1.26 for paraoxon; guinea pigs: 12.75 +/- 0.88 for parathion and 15.02 +/- 3.84 for paraoxon). In the lungs of both species, there was a linear relation between y, the percentage of cholinesterase inhibition induced by either organophosphate, and X, the total amount of drug taken up by the lung tissue (in nmol/g/18 min). The following equations were obtained: y = 0.128 x + 0.979 (R2 = 0.89, p < 0.001 for paraoxon); y = 0.120 x - 6.57 (R2 = 0.82, p < 0.005 for parathion). No difference was observed between the two organophosphates. After treatment with the cytochrome P450 inhibitor piperonyl butoxide, the above relations ceased to apply, but this treatment did not influence the kinetics of paraoxon and parathion uptake. The IC50 value calculated for paraoxon, i.e., the paraoxon concentration required to produce 50% inhibition of lung cholinesterase activity, was similar for guinea pigs (2.22 10(-7) +/- 0.22 M) and rabbits (2.36 10(-7) +/- 0.24 M). In conclusion, the biexponential evolution of the velocity of paraoxon and parathion uptake by the lungs thus demonstrates the presence of two pools. The lower extraction ratios calculated for rabbit lungs reflect the lower initial uptake velocity of the second compartment. In the range of concentrations investigated in guinea pigs, no saturable mechanism could be demonstrated for paraoxon and parathion. Cytochrome P450-related lung metabolic activity, through which parathion is converted to paraoxon, appears as a major step in parathion-induced lung cholinesterase inhibition, although it does not appear to affect parathion toxicokinetics.

Animals↗
PubMed1976

The cytochemical localization of cholinesterase activity in the developing chick heart.

The electronhistochemical localization of the cholinesterases of developing chick heart muscle cells has been studied with the aid of a substrate which incorporates an enzyme-susceptible thiolester group and a diazonium group into the same molecule. The embryonic chick heart exhibits cholinesterase activity from Hamilton-Hambruger stage 3 through to four days post hatching. Although enzyme activity is not demonstrated in every location at all stages studied, it has been observed on the nuclear envelope, golgi complex, rough and smooth endoplasmic reticulum, mitochondria and myofilaments. A change in the type of activity has been demonstrated, acetylcholinesterase is found during the first fourteen days of development but thereafter, non-specific cholinesterase is seen instead. As nerves have not been found in relation to the working myocardium, further support is given to the concept that an acetylcholine-cholinesterase system of myogenic origin is involved in spontaneous contraction. Consideration of the distribution of enzyme within the myocardial cell, raises the possibility that cholinesterase may be concerned in a regulatory mechanism of protein synthesis, a suggestion made previously in connection with liver cells.

Animals↗
PubMed1986

The use of mRNA translation in vitro and in ovo followed by crossed immunoelectrophoretic autoradiography to study the biosynthesis of human cholinesterases.

The synthesis of various cholinesterases in different fetal human tissues was studied using in vitro and in ovo translation of poly(A)+ RNA, followed by crossed immunoelectrophoretic autoradiography. When unfractionated poly(A)+ mRNA from fetal brain, muscle, or liver was translated in vitro, in the reticulocyte lysate cell-free system, polypeptides were synthesized which reacted with antibodies against either "true" acetylcholinesterase (acetylcholine hydrolase; EC 3.1.1.7) or "pseudo", butyrylcholinesterase (acylcholine acylhydrolase; EC 3.1.1.8). The two nascent cholinesterases could be separated by crossed immunoelectrophoresis followed by autoradiography, suggesting that acetylcholinesterase and butyrylcholinesterase are produced in all three tissues from nascent polypeptides containing different immunological domains. To examine whether the biosynthesis of cholinesterases includes posttranslational processing events, Xenopus oocytes were microinjected with mRNA from these tissues. Immunoelectrophoretic analysis of oocyte intracellular homogenates and incubation medium revealed various precipitation arcs, reflecting the synthesis and posttranslational processing of multiple forms of tissue-specific exported and intracellular acetylcholinesterase and butyrylcholinesterase. These findings demonstrate that polymorphic cholinesterases are produced from nascent polypeptide products which undergo further posttranslational processing events in a tissue-specific manner before they become mature compartmentalized cholinesterases.

Acetylcholinesterase↗
PubMed1991

Cholinesterases during development of the avian nervous system.

1. Long before onset of synaptogenesis in the chicken neural tube, the closely related enzymes butyrylcholinesterase (BChE) and acetylcholinesterase (AChE) are expressed in a mutually exclusive manner. Accordingly, neuroblasts on the ventricular side of the neural tube transiently express BChE before they abruptly accumulate AChE while approaching the outer brain surface. 2. By exploiting AChE as a sensitive and early histochemical differentiation marker, we have demonstrated complex polycentric waves of differentiation spreading upon the cranial part of the chicken neural tube but a smooth rostrocaudal wave along the spinal cord. Shortly after expression of AChE, these cells extend long projecting neurites. In particular, segmented spinal motor axons originate from AChE-positive motoneurones; they navigate through a BChE-active zone within the rostral half of the sclerotomes before contacting BChE/AChE-positive myotome cells. At synaptogenetic stages, cholinesterases additionally are detectable in neurofibrillar laminae foreshadowing the establishment of cholinergic synapses. 3. In order to elucidate the functional significance of cholinesterases at early stages, we have investigated specific cholinesterase molecules and their mechanisms of action in vivo and in vitro. A developmental shift from the low molecular weight forms to the tetramers of both enzymes has been determined. In vitro, the addition of a selective BChE inhibitor leads to a reduction of AChE gene expression. Thus, in vivo and in vitro data suggest roles of cholinesterases in the regulation of cell proliferation and neurite growth. 4. Future research has to show whether neurogenetic functioning of cholinesterases can help to understand their reported alterations in neural tube defects, mental retardations, dementias and in some tumours.

Acetylcholine↗
PubMed1985

Histochemical demonstration of monoaminergic and cholinesterase-positive nerve fibres in regenerating rat submandibular gland autografts.

A cholinesterase localization method and a monoamine histofluorescence technique were used to locate nerve fibres in regenerating rat submandibular gland autografts. Experimental rats had a portion of one submandibular gland excised and cut into small fragments which were autografted immediately into the middle one-third of the tongue. Control rats had a portion of one submandibular gland removed and discarded, and their tongues were sham-operated. Seven to ten weeks later, the rats were killed and the tongues were removed, frozen and sectioned in a cryostat. A light microscopical study of the tongue sections subjected to the cholinesterase technique showed that the submandibular gland autografts contained many nerve fibres that exhibited cholinesterase activity. These cholinesterase-positive nerve fibres were distributed throughout the autografts. The fibres were associated with the numerous duct-like structures and the less numerous acini. In addition, ultraviolet illumination of tongue sections after treatment with a glyoxylic acid mixture revealed histofluorescent monoaminergic nerves within the autografts. These fibres were less prominent than the cholinesterase-positive fibres and appeared to run primarily along blood vessels within the autografts. The results suggest that autonomic nerves are present within regenerating submandibular gland autografts.

Animals↗
PubMed1981

Acetylcholinesterase from rat red cells and cholinesterase of Pseudomonas aeruginosa: different types of inhibition by atropine.

The inhibition by atropine of cholinesterase from Pseudomonas aeruginosa has been studied in parallel with the membrane bound acetylcholinesterase from rat red cells. Acetylcholinesterase of rat red cells, like other animal cholinesterases, was competitively inhibited while the cholinesterase from Pseudomonas aeruginosa was partially non competitively inhibited by atropine. These results clearly indicated a different behavior of cholinesterase from Pseudomonas aeruginosa in comparison with the enzyme of Pseudomonas fluorescens and other animal cholinesterases.

Acetylcholinesterase↗
PubMed1986

Shortened action of succinylcholine in individuals with cholinesterase C5 isozyme.

To test the possibility that individuals with and without plasma cholinesterase C5 isozyme have differences in neuromuscular sensitivity to succinylcholine chloride, we examined the effects of succinylcholine in these two groups of patients. Sera from 491 adult patients were examined for presence of the plasma cholinesterase C5 isozyme by use of electrophoresis with polyacrylamide; 24 were positive for the C5 isozyme. Plasma cholinesterase activity and duration of action of succinylcholine were measured in 12 C5 positive patients and 18 C5 negative patients, all of whom had the normal cholinesterase genotype. C5 positive patients had 30.1 per cent higher mean plasma cholinesterase activity than C5 negative patients. The duration of neuromuscular blockade, measured by the first twitch height evoked by train-of-four stimulation, was significantly shorter in C5 positive patients than C5 negative patients. The C5 positive individuals had shorter duration of action of succinylcholine than C5 negative individuals.

Adult↗
PubMed1994

Cholinesterase activity in the plaques, tangles and angiopathy of Alzheimer's disease does not emanate from amyloid.

Previous histochemical observations in our laboratory have demonstrated the presence of butyrylcholinesterase and an enzymatically altered form of acetylcholinesterase activity in the plaques, tangles and amyloid-containing vessels of Alzheimer's disease. These findings suggested possible interactions between amyloid and cholinesterases. In this study we employed a cholinesterase biochemical assay to determine whether the amyloid precursor protein either had cholinesterase activity itself or influenced the enzymatic activity of cholinesterases. None of the three amyloid precursor sequences used (695, 751, 770, up to 16 micrograms/ml) exhibited any acetylcholinesterase or butyrylcholinesterase activity that could be detected by our method. In addition, none of the amyloid precursor proteins influenced the enzymatic activity of purified acetylcholinesterase or butyrylcholinesterase in a specific manner. It is therefore quite unlikely that amyloid can, by itself, account for the intense cholinesterase activity associated with the pathological lesions of AD.

Alzheimer Disease↗
PubMed1978

Cholinesterase in serum and low density lipoprotein of hyperlipidemic patients.

Cholinesterase activity in the low density lipoprotein fraction of serum is increased in types IIa, IIb and IV hyperlipoproteinemic patients, whereas only types IIb and IV show increases in serum cholinesterase activity. In obese patients, cholinesterase activity is increased both in the serum and low density lipoprotein fraction only when hyperlipidemia is present. Cholinesterase activity is also found to increase in proportion with increases in low density lipoprotein, cholesterol, and triglycerides both in the serum and low density lipoprotein fraction. We suggest on the basis of these findings that cholinesterase has a function in lipid and lipoprotein metabolism.

Cholesterol↗
PubMed1984

Effects of inhaled hexamethylene diisocyanate (HDI) on guinea pig cholinesterases.

Hexamethylene diisocyanate, HDI, a starting material in the production of many polyurethane products, was found to inhibit stoichiometrically mammalian and electric eel cholinesterases in an in vivo system (W. E. Brown, A. H. Green, M. H. Karol, and Y. Alarie , 1982, Toxicol . Appl. Pharmacol. 62, 45-52). The current study examined in vivo effects on guinea pig cholinesterases resulting from inhalation of HDI. Guinea pigs were exposed to atmospheres of 0.5, 1.8, or 4.0 ppm HDI (ceiling value = 0.02 ppm) for up to 6 hr. Blood samples were drawn prior to exposure and at specified times during exposure. No inhibition of serum cholinesterase was detected following exposure to 0.5 ppm HDI for 6 hr, to 1.8 ppm HDI for 2 hr, or to 4.0 ppm HDI for 3 hr. Similarly, no inhibition was detected when erythrocytes from each blood sample were assayed for acetylcholinesterase activity. Last, animals were sacrificed and cholinesterase activity determined in bronchial lavage fluid. Enzyme levels of HDI-exposed animals were not significantly different (P greater than 0.05) from those of control animals exposed to water vapor. In conclusion, although in vitro experiments had demonstrated potent anticholinesterase activity by HDI, in vivo inhalation exposure of guinea pigs to HDI at concentrations 25-200 times above the recommended (ACGIH) ceiling value did not produce measurable inhibition of cholinesterase activity.

Acetylcholinesterase↗
PubMed1987

Effects of inhaled cholinesterase inhibitors on bronchial tonus and on plasma and erythrocyte acetylcholine esterase activity in rats.

Young adult male and female Wistar rats were inhalationally exposed head-only for 1 or 4 h to different anticholinesterase aerosols. The compounds tested were dichlorvos, fenamiphos, methamidophos, parathion, a pyrimidine thiophosphate and the carbamate propoxur. These compounds are direct or indirect inhibitors of cholinesterase activity. Immediately after termination of exposure to the compounds, the rats were anesthetized with barbiturate and subjected to pulmonary function tests. An acetylcholine provocation test was performed to correlate the effect of the cholinesterase inhibition and lung resistance. The results basically revealed that by inhalation exposure bronchoconstriction in the absence of acetylcholine provocation did not occur at toxicologically significant doses of the pesticides. An increase in lung resistance was observed only after provocation. However, measurements of plasma cholinesterase activity proved to be more sensitive than the provocation test. With regard to their diagnostic value, the results of the reported study may be summarized as follows (beginning with the most sensitive parameter): plasma cholinesterase activity depression greater than or equal to acetylcholine-induced bronchoconstriction greater than or equal to cholinergic symptoms greater than erythrocyte cholinesterase activity depression greater than pulmonary resistance without acetylcholine provocation.

Acetylcholinesterase↗
PubMed1990

Association between rat serum cholinesterase and some phospholipid components of lipoproteins in thioacetamide-induced hepatic injury.

Rat serum lipoprotein phospholipids and serum cholinesterase activity in control and thioacetamide-treated rats (50 mg/kg/day for 30 days) were studied. Analyses were done after 1, 3, 8 and 30 intraperitoneal doses of thioacetamide or 0.15 mol/l NaCl. Cholinesterase activity significantly increased with thioacetamide treatment. Only two phospholipids: LDL-phosphatidylcholine and HDL-lysophosphatidylcholine appeared associated with cholinesterase activity. LDL-phosphatidylcholine increased through the action of hepatotoxic thioacetamide while HDL-lysophosphatidylcholine significantly decreased. Because of the high statistically significant association between changes in these lipoprotein phospholipids and in cholinesterase in this model of hepatic injury, we conclude that cholinesterase could be involved in the regulation of these phospholipid levels.

Acetamides↗
PubMed2005

Serum cholinesterase activity in diabetes and associated pathologies.

Serum cholinesterase activity was measured in diabetes, hypertensive and diabetic/hypertensive patients. The sample consisted of volunteer patients and was divided in a control group (n=26), type 2 diabetic group (n=16), hypertensive group (n=12) and type 2 diabetic/hypertensive group (n=26). In addition, blood glucose, cholesterol and triglyceride levels were determined. Serum cholinesterase activity in the control group was significantly lower in relation to the other groups (p<0.001). Blood glucose levels were elevated in type 2 diabetic and type 2 diabetic/hypertensive groups. In vitro studies showed increased cholinesterase activity in the presence of glucose 5-100mM or insulin 0.5-25 UI (p<0.001). Cholesterol and triglycerides were at normal levels only in the control group. Possibly, a relationship exists between the increase in serum cholinesterase and the vascular complications in the diabetic patients, potentially stimulated by the levels of glycemia and dyslipidemia. Although patients were receiving different medicines, the increase in enzyme activity was similar in all groups. This enzymatic profile suggests a possible interference of the diseases in the catalytic mechanism of the serum cholinesterase enzyme.

Antihypertensive Agents↗
PubMed1985

Cholinesterases in primary affective disorders.

Cholinesterase activities were measured in plasma (ChE) and in intact erythrocytes (AChE) in patients suffering from manic-depressive illness, their first degree relatives who were well, and unrelated normal volunteers. All the subjects were in a normal mood state at the time of testing. Plasma cholinesterase activity was found to be significantly lower than normal in bipolar (BP), unipolar (UP), other affective disorder (OA) and well subjects belonging to manic-depressive families. Intact erythrocyte cholinesterase (true cholinesterase) activity was also found to be significantly lower than normal in all the above mentioned patients and their relatives. Half of the BP subjects were on lithium treatment and their cholinesterase activities were similar to those patients not on lithium treatment. The data suggest a significant role of cholinergic mechanisms in the etiology of manic-depressive illness.

Adolescent↗