Abstract

We encountered a 79 year old female patient with mild cognitive impairment who showed sustained improvement to an almost normal level of global cognitive function for >1 year when treated with donepezil. Her levels of high-sensitivity C-reactive protein (hs-CRP) also showed a sustained decrease with treatment. Here, we describe the clinical changes in her cognition and discuss the relationship between cognitive function and low-grade inflammation, focusing on three important issues. First, cognitive dysfunction may be related to low-grade inflammation. Second, hs-CRP may be a suitable marker for this low-grade inflammation. Third, treatment with cholinesterase inhibitors was effective, either by suppressing this low-grade inflammation or by upregulating acetylcholine, which suppresses such inflammation. In this patient, inflammation appeared to be related to the cholinergic anti-inflammatory pathway.

Keywords: Acetylcholine; Cholinergic anti-inflammatory pathway; High sensitive C-reactive protein; Low grade inflammation; Pseudodementia