The cholinergic hypothesis of neuropsychiatric symptoms in Alzheimer's disease.

A variety of neuropsychiatric symptoms occur in Alzheimer's disease (AD) including agitation, psychosis, depression, apathy, disinhibition, anxiety, purposeless behavior, and disorders of sleep and appetite. Neuropsychiatric symptoms have been related to cholinergic deficiency and improve after treatment with cholinomimetic agents. Cholinergic drugs are unique among psychotropic agents in exerting disease-specific and broad-spectrum effects. These observations provide the basis for the cholinergic hypothesis of the neuropsychiatric symptoms of AD, suggesting that the cholinergic deficit of AD contributes to the neuropsychiatric symptoms of AD and that cholinomimetic therapy ameliorates the behavioral disturbances accompanying AD.