Clinical pharmacokinetics of arecoline in subjects with Alzheimer's disease

OBJECTIVE

To study the pharmacokinetics and pharmacodynamics of intravenously administered arecoline in subjects with Alzheimer's disease.

METHODS

Plasma arecoline concentrations were measured during and after high-dose (i.e., 5 mg intravenously over 30 minutes) and up to 2 weeks of continuous multiple-dose steady-state intravenous infusions of arecoline in 15 subjects with mild to moderate Alzheimer's disease. During multiple-dose infusions, the dose of arecoline was escalated from 0.5 to 40 mg/day. Psychometric tests were administered at baseline and every other dose to determine an "optimal dose" for each subject. This dose then was administered for 1 week using a randomized, placebo-controlled, double blind, crossover design. Plasma drug concentrations were measured by GC-MS.

RESULTS

The optimal dose of arecoline varied fourfold across subjects (4 mg/day, n = 6; 16 mg/day, n = 3) with mean plasma half-lives of 0.95 +/- 0.54 and 9.3 +/- 4.5 (SD) minutes. Clearance and volume of distribution were 13.6 +/- 5.8 L/min and 205 +/- 170 (SD) L, respectively. At the dose that optimized memory, the mean plasma level was 0.31 +/- 0.14 (SD) ng/ml, and it predicted the optimal dose in all subjects.

CONCLUSIONS

Because optimal dose variation is due to differing plasma kinetics, the plasma arecoline level measured at a single infusion rate can be used to choose the optimal dose for memory enhancement in patients with Alzheimer's disease.

Differential responsivity of mood, behavior, and cognition to cholinergic agents in elderly neuropsychiatric populations

To evaluate the possible differential responsivity of Alzheimer patients to cholinergic agents, a series of pharmacologic challenge studies in 83 neuropsychiatric patients and controls were performed contrasting a cholinergic antagonist (scopolamine) with two cholinergic agonists (arecoline and nicotine). Alzheimer patients displayed significantly greater behavioral and cognitive responses to central cholinergic blockade at lower scopolamine doses than age-matched controls or elderly depressives. These differential changes could not be explained by group differences in the sedative, physiologic, or pharmacokinetic effects of the drug. In addition, the elderly, age-matched control subjects did reveal a profile of cognitive deficits at the highest dose (0.5 mg), which temporarily mimicked the baseline impairments found in early Alzheimer's disease. Together, these findings with scopolamine suggest an increased sensitivity to cholinergic blockade in Alzheimer's disease and demonstrate the first direct evidence of anticholinergic modelling of dementia in normal elderly subjects. To investigate further the postsynaptic cholinergic responsivity in Alzheimer's disease, patients were studied with arecoline and nicotine. While the cognitive effects of both agents were modest at best, there were significant differences in mood and behavioral responses between arecoline and nicotine in Alzheimer subjects. These behavioral changes occurred at much lower doses in the Alzheimer patients than those required in normal controls, once more supporting the notion of increased behavioral sensitivity to cholinergic agents in Alzheimer's disease. In addition, the differential mood effects between these two cholinergic agonists raise new questions about receptor selectivity in the cholinergic regulation of mood.

Tolerance to the disruptive effects of arecoline on schedule-controlled behavior

The roles of dispositional, physiological, and behavioral factors in the development of tolerance to the effects of arecoline on operant behavior were assessed. In Experiment I, rats were trained to press a lever on a variable-interval 15-s schedule for milk reinforcement. Dose-effect relationships were assessed prior to and during chronic arecoline (1.74 mg/kg/day) treatment. After 21 days of arecoline administration prior to each session, the dose-effect relationship for total number of responses did not shift. However, the dose-effect relationship for total number of reinforcers shifted to the right. In Experiment II, rats were trained to respond on a fixed-ratio 20 schedule for milk reinforcement. Dose-effect relationships were assessed prior to and during chronic arecoline (0.87 mg/kg/day) administration. One group of rats received daily injections of arecoline prior to the session and a second group received arecoline injections 30 min after the session. Daily administration of arecoline resulted in a greater shift to the right of the dose-effect relationship for the presession group than it did for the postsession group. These data demonstrate the importance of behavioral factors in the development of tolerance to arecoline.

Discriminative stimulus properties of arecoline: a new approach for studying central muscarinic receptors

Rats were trained to discriminate arecoline (1.74 mg/kg) from saline in a milk-reinforced (variable interval 12s) two-lever operant paradigm. The discriminative stimulus (DS) effects of arecoline were antagonized by atropine sulfate, but not by atropine methylnitrate or mecamylamine. In contrast to the effects on discrimination, atropine did not antagonize the response rate suppressant effects of arecoline. The DS effect of arecoline completely generalized to oxotremorine, partially generalized to pilocarpine, and did not generalize to nicotine. These data demonstrate that the DS effect of arecoline depends on central muscarinic receptors.