Study Design And Sampled Participants
This is retrospective matched-cohort research using the LHID between January 1, 2000, and December 31, 2015. Each patient aged 50 years or older was required to receive the treatment with first- and second generation H1RA in the inpatient and outpatient settings within the first one-year study period. A 1:3 sex-, age-, and insurance premium-matched, index year- matched, location-matched, level of care-matched, controls were randomly selected for each patient with H1RA. The exclusion criteria for the cohorts were unknown sex, subjects diagnosed with dementia or receiving H1RA before the index date, or < 50 years old during the study period. The index date was defined as the time when the individuals received their first H1RA within the one-year study period. Notably, self-reported over the counter H1RA usage and duration was not available because of the study design. Since antihistamines are contraindicated in the following conditions, individuals diagnosed with glaucoma, bladder neck obstruction, benign hypertrophy of prostate with urinary obstruction and other lower urinary tract symptoms, peptic ulcer with esophagus stricture, pyloric stricture and duodenal stricture were also excluded . Cumulative exposure was categorized by the estimated duration of the H1RA usage based on the total defined daily dose per package prescribed before any dementia diagnosis, as 1364 days, 3651,459 days, > 1,460 days with cut-points based on the clinical interpretability.
The Usage Of Histamine Type 1 Receptor Antagonist And Risk Of Dementia In The Elderly: A Nationwide Cohort Study
- 1Department of Psychiatry, Taoyuan Armed Forces General Hospital, Taoyuan, Taiwan
- 2Department of Psychiatry, Taoyuan Armed Forces General Hospital, Hsinchu Branch, Hsinchu City, Taiwan
- 3Department of Psychiatry, Tri-Service General Hospital, School of Medicine, National Defense Medical Center, Taipei, Taiwan
- 4Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan
- 5School of Public Health, National Defense Medical Center, Taipei, Taiwan
- 6Graduate Institute of Life Sciences, National Defense Medical Center, Taipei, Taiwan
- 7Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
- 8Graduate Institute of Aerospace and Undersea Medicine, National Defense Medical Center, Taipei, Taiwan
- 9Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
Background: The histamine type 1 receptor antagonist has been commonly used. This study aimed to examine the association between the usage of H1RA and the risk of dementia.
Methods: A total of 8,986 H1RA users aged 50 and 26,958 controls matched a ratio of 1:3 for age, sex, and comorbidity, were selected between January 1, and December 31, 2000, from Taiwans National Health Insurance Research Database. Fine and Grays survival analysis was used to compare the risk of developing dementia during a 15-year follow-up period .
The usage of H1RA was associated with the risk of developing dementia in the patients aged 65 years.
What Are The Limitations Of The Research
An important caveat with this type of study is that it is observational meaning there is no way to know if the medication use played any direct role in causing dementia. All it shows is that the risk of developing dementia appears to be higher for people who take some of these medications.
Its also possible, the authors note, some conditions, like depression, may be early harbingers of cognitive decline. Its possible, for example, that some people taking antidepressants might actually be being treated for what will turn out to be an early symptom of dementia, so its their depression that goes along with an increased risk of dementia not the medicine they are taking to treat it.
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Q If Youre Someone Who Is Taking These Medications What Should You Do
A. We recommend you takethese steps if you have any concerns:
- Speak to your doctor or geriatric team before you stop taking these medications: If you suddenly stop taking certain medications, you may experience worsening effects. Your provider can determine whether the medication should be tapered and may also be able to recommend safer substitutions you can use in their place or non-medication treatment options you can try.
- Be informed and ask questions: You may have been on a medication for years that youve tolerated well. But its fair to continually reevaluate your medications. Your body doesnt metabolize and respond to medications the same way it did 30 years ago. So bring your questions to your provider to help start the conversation.
- Speak with your provider about any over-the-counter medications youre taking: Those medications still can have side effects and may be doing more harm than good. You can either ask your geriatrician or your pharmacist.
Common Meds And Dementia: How Strong Is The Link
May 9, 2016 — Could your chances of getting dementia depend on whatâs in your medicine cabinet?
A new study found that medicines taken by millions for depression, asthma, allergies, and other conditions may raise that risk.
The drugs involved in the study are known as anticholinergics. They work by blocking a brain chemical called acetylcholine, which is crucial for memory. Although this isnât the first time researchers have looked at this link, the new study looked at about 100 over-the-counter and prescription drugs that work in this way, ranging from the antidepressant Paxil to the allergy drug Benadryl to the motion sickness remedy Dramamine .
The experts found a strong link between the drugs and dementia, but they didn’t prove the meds directly cause it. WebMD asked the lead researcher on the recent study and an expert on Alzheimer’s disease to help people taking the drugs understand what to know and do.
What did this study actually show regarding these drugs and dementia?
The brains of those people taking the medicine did not work as well as the brains of those not taking them. “We saw an increased risk of getting dementia over time,” says researcher Shannon Risacher, PhD, assistant professor of radiology and imaging sciences at the Indiana University School of Medicine.
Study participants took the medicines on average for about 7 years.
Are some of the drugs more likely to increase the risk of dementia than others?
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Q How Do Anticholinergics Affect Dementia Risk
A. Anticholinergic drugs actby blocking acetylcholine, a chemical involved in nervous system functions.When the drugs block these functions in the brain, it can cause cognitivechanges. As you age, you become more sensitive to the effects of thesemedications.
And although we dont yet have proof that they cause dementia, weoften find that patients cognitive function improves when they are no longeron these medications.
Antihistamines Part Ii: Long
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The last Pharmacology Consult column, Antihistamines for the common cold: Wheres the evidence? , reviewed recently published data suggesting that antihistamine product use may be increasing for the treatment of common cold symptoms. Because recent recommendations and regulations have decreased the use of cough/cold products in the pediatric population, pediatric health care providers may be turning to antihistamine-based products instead. Commonly used first-generation antihistamines have strong anticholinergic properties, and recently published data from the adult population have suggested that long-term use of these drugs may increase the risk for developing dementia. As summaries of these publications find their way to the lay media, it is understandable that parents may wonder about the long-term safety of using antihistamines in children. Although the diagnosis of dementia is certainly not associated with the pediatric population, parents may still express concern about the adverse effects and long-term safetyof antihistamines.
Second-generation antihistamines , considered nonsedating because of their relative lack of CNS penetration, are commonly prescribed to children and adults for allergic conditions. Second-generation antihistamines display no significant anticholinergic pharmacologic actions.
Anticholinergic drugs and dementia risk
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Diphenhydramine Use And Dementia
While there is no direct correlation to diphenhydramine causing dementia, there have been studies released that highlight its ability to increase the chances of developing dementia. A team led by Shelly Gray, a pharmacist at the University of Washingtons School of Pharmacy, tracked nearly 3,500 men and women age 65 and older. These individuals took part in Adult Changes in Thought , a long-term study conducted by the University of Washington and Group Health. They utilized pharmacy records to determine which drugs, both prescription and over-the-counter, that each participant indulged in during the past 10 years. Their health was also tracked for an average of seven years.
During this span, 800 of the volunteers developed dementia. When the research was broken down, researchers examined the use of anticholinergic drugs and found that those who used medications like diphenhydramine were at an increased risk of developing dementia than those who did not use the drugs. Taking one of these anticholinergic drugs for the equivalent of three years was associated with a 54 percent higher dementia risk than the individuals who took it for three months or less.
While diphenhydramine may seem like a harmless medication because of its easy, over-the-counter access, long-term use of any substance can prove to be fatal or have life-threatening consequences. If you or someone you know is consuming large doses of diphenhydramine, it may be a sign to seek treatment.
Common Anticholinergic Drugs Like Benadryl Linked To Increased Dementia Risk
- By Beverly Merz, Executive Editor, Harvard Women’s Health Watch
One long-ago summer, I joined the legion of teens helping harvest our valleys peach crop in western Colorado. My job was to select the best peaches from a bin, wrap each one in tissue, and pack it into a shipping crate. The peach fuzz that coated every surface of the packing shed made my nose stream and my eyelids swell. When I came home after my first day on the job, my mother was so alarmed she called the family doctor. Soon the druggist was at the door with a vial of Benadryl tablets. The next morning I was back to normal and back on the job. Weeks later, when I collected my pay , I thanked Benadryl.
Today, Im thankful my need for that drug lasted only a few weeks. In a report published in JAMA Internal Medicine, researchers offers compelling evidence of a link between long-term use of anticholinergic medications like Benadryl and dementia.
Anticholinergic drugs block the action of acetylcholine. This substance transmits messages in the nervous system. In the brain, acetylcholine is involved in learning and memory. In the rest of the body, it stimulates muscle contractions. Anticholinergic drugs include some antihistamines, tricyclic antidepressants, medications to control overactive bladder, and drugs to relieve the symptoms of Parkinsons disease.
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Why Is A Good Nights Sleep So Important To Overall Brain Health
One of the things were learning more about is that neurocognitive disorders arise from little perturbations in brain metabolism that lead to the gradual buildup of protein deposits over many years. Exposure to diphenhydramine over the short term can make older folks a little squirrely, but long-term use over many years may lead to Alzheimers disease.
If people are unable to achieve a good nights sleep, they really need to consult with a physician. Were learning more and more how important sleep is for not just short-term brain functioning, but for long-term brain functioning as well.
One of the current theories about what contributes to the development of neurodegenerative disorders is the accumulation of toxic substances in our brains over many years. Weve learned that sleep plays a role in eliminating these toxic substances. One of the consequences of not getting enough sleep is that these substances stay in the brain and cause a little bit of damage, which, multiplied over many years, can lead to a neurodegenerative disorder.
So a good nights sleep isnt just important for how you do the next day, but not sleeping well over a long period of time can have very dire consequences.
Do Drugs Like Benadryl And Paxil Increase Dementia Risk Research Is Limited
Can certain medications increase your risk of dementia?
A new study suggests that people who take a class of common medicines called anticholinergic drugs for several years may be more likely to develop dementia as they age.
This is not a new hypothesis about these drugs, which are used to treat a wide range of conditions from depression and epilepsy to incontinence. But the study, published in the journal JAMA Internal Medicine, is large, and it analyzed the use of the medications in more detail and over a longer period of time than many earlier studies.
Here’s what is known about the potential link between anticholinergic medicines and dementia:
Which drugs are we talking about?
Anticholinergic drugs include the antipsychotic clozapine the bladder drug darifenacin the anti-nausea drug scopolamine the bronchodilator ipratropium the muscle relaxant tizanidine antihistamines such as diphenhydramine and antidepressants such as paroxetine .
These medications work by blocking a chemical called acetylcholine, which acts as a neurotransmitter and is involved in many nervous system functions, including muscle movements, heart rate, the widening of blood vessels, respiratory functions and muscle contractions in the stomach during digestion.
What does research show?
Other studies have also suggested that long-term use of some anticholinergic medications might increase the risk that older people will develop dementia.
What did the new study involve?
What’s the bottom line?
Higher Dementia Risk Linked To More Use Of Common Drugs
- Group Health Research Institute
- A large study links a significantly increased risk for developing dementia, including Alzheimer’s disease, to taking commonly used medications with anticholinergic effects at higher doses or for a longer time. Many older people take these medications, which include nonprescription diphenhydramine .
A large study links a significantly increased risk for developing dementia, including Alzheimer’s disease, to taking commonly used medications with anticholinergic effects at higher doses or for a longer time. Many older people take these medications, which include nonprescription diphenhydramine . JAMA Internal Medicine published the report, called “Cumulative Use of Strong Anticholinergic Medications and Incident Dementia.”
The study used more rigorous methods, longer follow-up , and better assessment of medication use via pharmacy records to confirm this previously reported link. It is the first study to show a dose response: linking more risk for developing dementia to higher use of anticholinergic medications. And it is also the first to suggest that dementia risk linked to anticholinergic medications may persist — and may not be reversible even years after people stop taking these drugs.
Can You Reverse Memory Problems From Anticholinergic Drugs
Many people, including a lot of health professionals, are unaware how many medications have anticholinergic activity. Perhaps even more alarming are the complications from a big anticholinergic burden. The more medicines a person takes that have anticholinergic activity the greater the risk of side effects such as memory problems, as this reader discovered:
Q. Are there antidotes to anticholinergic drugs? I have taken Benadryl , Paxil and oxybutynin for years.
I have read that such drugs can affect the brain. I feel as though my memory is half gone.
I am 83 and had a very good brain and a high IQ. I am worried and hope there are ways to reverse my mental decline.
A. There is growing recognition that drugs affecting the brain chemical acetylcholine can impair mental function, especially in older people . The medications you mention all have anticholinergic activity and could contribute to memory problems.
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Benadryl For Hives Itching And Rash
Some topical, over-the-counter Benadryl products are approved for treating hives, itchy skin, and rash. These products include:
- Benadryl Itch Stopping Cream
- Benadryl Itch Stopping Gel
- Benadryl Itch Relief Stick
Oral over-the-counter Benadryl products arent approved to treat hives, itchy skin, and rash. However, these products are sometimes used for these purposes. Theyre effective for this use, but theyre not usually a first-choice treatment because of side effects such as sleepiness.
Newer, second-generation antihistamines are usually preferred over oral Benadryl for treating these symptoms. These newer medications include:
- Benadryl Itch Relief Stick
Is There Anything I Can Take Safely If Im Having Trouble Getting Sleep
If sleep is a problem, there are several things people can do. There are other natural products people can take to help them get some sleep, such as melatonin. As far as we know, melatonin in general is a perfectly good substitute for diphenhydramine. Its a natural supplement. Its the chemical in the brain that actually induces sleep in a natural way.
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How Anticholinergic Drugs Work
Anticholinergic drugs block the neurotransmitter acetylcholine, which controls many bodily functions like involuntary muscle movement.
Anticholinergics are most often used for urinary incontinence because they affect neurons which encourage muscle contraction, but they also influence physical capabilities and memory storage and retrieval.
What makes these drugs even more dangerous is that many over-the-counter drugs are considered anticholinergics or have anticholinergic effects. Many doctors dont even warn patients that their medication may have severe consequences if taken for a long time.
What The Study Found Regarding Benadryl And Dementia
A team led by Shelley Gray, a pharmacist at the University of Washingtons School of Pharmacy, tracked nearly 3,500 men and women ages 65 and older who took part in Adult Changes in Thought , a long-term study conducted by the University of Washington and Group Health, a Seattle healthcare system. They used Group Healths pharmacy records to determine all the drugs, both prescription and over-the-counter, that each participant took the 10 years before starting the study. Participants health was tracked for an average of seven years. During that time, 800 of the volunteers developed dementia. When the researchers examined the use of anticholinergic drugs, they found that people who used these drugs were more likely to have developed dementia as those who didnt use them. Moreover, dementia risk increased along with the cumulative dose. Taking an anticholinergic for the equivalent of three years or more was associated with a 54% higher dementia risk than taking the same dose for three months or less.
The University of Washington study is the first to include nonprescription drugs. It is also the first to eliminate the possibility that people were taking a tricyclic antidepressant to alleviate early symptoms of undiagnosed dementia the risk associated with bladder medications was just as high.
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