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TCT May Blunt Anticholinergic Medication Burden

Schizophr Res; ePub 2019 Feb 6; Joshi, et al

Targeted cognitive training (TCT) may blunt anticholinergic medication burden associated reduction in verbal learning in severely disabled inpatients with schizophrenia, according to a recent study. Patients with schizophrenia mandated to a locked residential rehabilitation center were randomized to treatment as usual (TAU; n=22) or a course of TAU augmented with TCT (n=24). Anticholinergic medication burden was calculated from medication data at baseline and follow-up using the Anticholinergic Cognitive Burden (ACB) Scale. MATRICS Consensus Cognitive Battery Verbal Learning domain scores were used as the primary outcome variable. The TAU and TCT groups were matched in ACB at baseline and follow-up. Researchers found:

  • While baseline ACB was not associated with verbal learning in either group, increases in ACB over the course of the study were significantly associated with deterioration of verbal learning in the TAU group (r = −0.51).
  • This was not seen in subjects randomized to TCT (r = −0.13).


Joshi YB, Thomas ML, Hochberger WC, et al. Verbal learning deficits associated with increased anticholinergic burden are attenuated with targeted cognitive training in treatment refractory schizophrenia patients. [Published online ahead of print February 6, 2019]. Schizophr Res. doi:10.1016/j.schres.2019.01.016.


Schizophrenia is treated with medications that increase the level of anticholinergic activity and this has a negative effect on cognitive functioning. Deficits in attention and memory are known to contribute to functional impairment in people with schizophrenia, highlighting the importance of reducing medication-induced anticholinergic effects in order to optimize functional status and recovery. This study examined the potential utility of targeted cognitive training (TCT) in reducing or attenuating the effects of anticholinergic load on individuals with severe schizophrenia. The fact that patients who received TCT showed a significant gain in global cognition and that this improvement was negatively correlated with anticholinergic load suggests several important clinical implications. First, reducing anticholinergic activity associated with medication treatment has practical impact, and should be considered in treatment. Additionally, TCT has a potential role in reducing medication adverse effects and improving outcomes, even among the most severally ill patients with schizophrenia.—Martha Sajatovic, MD, Professor of Psychiatry and of Neurology; Willard Brown Chair in Neurological Outcomes Research; Director, Neurological and Behavioral Outcomes Center, University Hospitals Cleveland Medical Center; Case Western Reserve University School of Medicine.