Medications That Block The Effects Of Acetylcholine
Among the best-recognized cognitively dangerous medications are those with anticholinergic properties. This means that the medications block the effect of acetylcholine, an important brain chemical and neurotransmitter that becomes less plentiful in the aging brain. These medications have an impact on brain cells by occupying its receptor molecules, and can help people gain relief from symptoms of insomnia, irritable bowel syndrome, or several other medical conditions. Also, many medications valued for their other effects have incidental anticholinergic properties. Among the clinically significant anticholinergic medications are medications such as tolteridine, often used to treat urinary incontinence. In addition, some antidepressants , antipsychotics, cardiac medications, antispasmodics, antivertigo medications, and antiparkinsonian medications have anticholinergic effects.
Unfortunately, the undesired consequences of anticholinergic medications can be serious. Dry mouth, dry eyes, constipation, or urinary retention may occur. The toxic effects of anticholinergic medications on the brain include confusion, memory disturbance, agitation, and even delirium.
If Youre Experiencing Forgetfulness Or Confusion Check Your Medicine Cabinet
For a long time doctors dismissed forgetfulness and mental confusion as a normal part of aging. But scientists now know that memory loss as you get older is by no means inevitable. Indeed, the brain can grow new brain cells and reshape their connections throughout life.Most people are familiar with at least some of the things that can impair memory, including alcohol and drug abuse, heavy cigarette smoking, head injuries, stroke, sleep deprivation, severe stress, vitamin B12 deficiency, and illnesses such as Alzheimer’s disease and depression.
But what many people don’t realize is that many commonly prescribed drugs also can interfere with memory. Here are 10 of the top types of offenders.
Could Medications Contribute To Dementia
- By Robert H. Shmerling, MD, Senior Faculty Editor, Harvard Health Publishing
Alzheimers disease and other illnesses that cause dementia are devastating, not only for those affected but also for their friends and family. For most forms of dementia, there is no highly effective treatment. For example, available treatments for Alzheimers disease may slow the deterioration a bit, but they dont reverse the condition. In fact, for most people taking medications for dementia, it may be difficult to know if the treatment is working at all.
Experts predict that dementia will become much more common in the coming years. We badly need a better understanding of the cause of these conditions, as this could lead to better treatments and even preventive measures.
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Senior Living And Medication Care Plans
For many seniors, a move to an assisted living community can help get this medication chaos under control. Most assisted living communities require that residents have a doctors visit before admission. Families and physicians often use this visit as an opportunity to press the reset button on prescriptions. A complete reassessment of the seniors medication regime can take place at this time. Under doctors supervision, many seniors are able to go off of medicines that are redundant or have outgrown their usefulness.
Once a senior is admitted to assisted living, a care plan is put in place. Care plans lay out goals and strategies for the residents care, and medicines are a big part of the equation. The community, family, senior and medical professionals discuss what medicines will be given to the resident, why, and often set goals for reducing them. In fact, seniors, particularly those with Alzheimers and dementia, are often able to reduce their medications after moving to assisted living communities with memory care.
In fact, many seniors who have been prescribed anti-anxiety medications find themselves in an undignified stupor thats not only painful for loved ones to witness, but also can lead to falls, head injuries and broken bones. Todays memory care communities attempt to reduce this agitation and anxiety non-chemically, with methods such as:
Emerging Evidence Of Drug Induced Dementia
Researchers find anticholinergic drugs may cause vascular dementia.
There is emerging evidence that anticholinergic drugs might cause vascular dementia in people age 50 years and older, who would otherwise not be expected to get dementia. This type of dementia is not genetic, like Alzheimer disease.
Anticholinergic drugs are on the Beer’s list of drugs not to give people over 65 because they can cause short term confusion, memory loss and altered mental status.1 It has also been observed that people who take cholinergic drugs for long periods have a higher rate of dementia.2 There is even a list of anticholinergic drugs with a rating scale on the adverse cognitive side effects.3
More studies are being done to understand this connection. Most recently was a case control study recently published in JAMA.4
Information was gathered from the QResearch primary care database in England. The study looked at 58,769 patients with a diagnosis of dementia and 225,574 controls who did not have dementia. It specifically evaluated people age 55 years and older and the exposure to anticholinergic drugs.
The finding of this strong association between anticholinergic drugs and vascular dementia, rather than for other types of dementia, is new information. It raises questions how anticholinergic drugs cause permanent damage. Proposed mechanisms are vascular and inflammatory changes, as well as chronic cholinergic depletion.
References
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Medications Associated With Delirium
Many groups of drugs can cause delirium. This includes prescription, over the counter, complementary/alternative, or illicit products. Observational studies show that the most common drugs associated with delirium are sedative hypnotics , analgesics , and medications with an anticholinergic effect. Other medications in toxic doses can also cause delirium. Drugs may indirectly contribute to delirium by causing syndromes such as serotonin syndrome, neuroleptic malignant syndrome, or secretion of inappropriate antidiuretic hormone.
Parkinsonism Vs Parkinsons Disease
Parkinsonism refers to a cluster of symptoms that mimic the movement problems caused by Parkinsons disease. Its sometimes referred to as atypical Parkinsons disease, secondary parkinsonism, or Parkinsons plus.
Parkinsons disease is a chronic, neurodegenerative brain disorder. In addition to problems with movement, Parkinsons disease causes non-motor symptoms that arent caused by drug-induced parkinsonism. They include:
- depression
- constipation
- anosmia
Another key difference between drug-induced parkinsonism and Parkinsons disease is symmetry. Drug-induced parkinsonism usually affects both sides of the body equally. Parkinsons disease affects one side of the body more than the other.
Parkinsonism can be caused by medications, repeated head trauma, and environmental toxins. It can also be caused by neurological disorders, including Parkinsons disease. Other neurological conditions that cause parkinsonism include:
- progressive supranuclear palsy
These medications dont cause resting tremors. Rather, they cause:
- Action tremors. These occur in a body part thats moving, not a body part thats resting.
- Postural tremors. These occur when a body part is forced to withstand gravity, such as when arms are outstretched or legs are raised.
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Where To Learn About Other Drugs That Affect Brain Function
Many other drugs that affect brain function, but they are either not used as often as the ones above, or seem to affect a minority of older adults.
Notably, there has been a lot of concern in the media about statins, but a meta-analysis published in 2015 could not confirm an association between statin use and increased cognitive impairment. In fact, a 2016 study found that statin use was associated with a lower risk of developing Alzheimers disease.
This is not to say that statins arent overprescribed or riskier than we used to think. And its also quite possible that some people do have their thinking affected by statins. But if you are trying to eliminate medications that dampen brain function, I would recommend you focus on the ones I listed above first.
For a comprehensive list of medications identified as risky by the experts at the American Geriatrics Society, be sure to review the 2019 Beers Criteria.
You can also learn more about medications that increase fall risk in this article: 10 Types of Medications to Review if Youre Concerned About Falling.
What Is A Combination Drug
the word poly means a lot, and pharmacy Refers to medicines. Thus, polypharmacy is the use of too many drugs to treat a person. Polypharmacy is necessary and appropriate in many situations, but the use of polypharmacy, especially in older adults, also has the potential to have unintended negative effects.
There are several contributing factors to polypharmacy, including:
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Central Nervous System Drugs
Benzodiazepines are lipid soluble medications that have a prolonged half life in the elderly because of accumulation in lipid tissue. Because of the extended duration of action and increased sensitivity to sedative hypnotics in the elderly, benzodiazepines can cause delirium. Benzodiazepines are independently associated as a risk factor for delirium.
Metabolic And Toxic Causes
Several endocrinal disorders and vitamin deficiencies can masquerade as dementia and need to be investigated, especially in young and rapidly progressive dementias. Several toxins can cause RPD. Exposure to heavy metals, such as arsenic, mercury, aluminum, lithium, or lead, can lead to cognitive decline, particularly after acute exposure. Most cases of acute exposures result in florid encephalopathies that progress over hours to days and thus would not be confused with rapidly progressive dementias, which progress over weeks to months. Manganese toxicity, found usually in miners, can present with significant Parkinsonism. Bismuth is a metal used to treat gastrointestinal disorders, principally peptic ulcer disease and diarrhea. Bismuth intoxication, typically caused by overdosing on bismuth-containing products, such as Pepto-Bismol, can cause a disorder mimicking Creutzfeldt-Jakob disease . Patients initially manifest with apathy, mild ataxia, and headaches, which progress to myoclonus, dysarthria, severe confusion, hallucinations , seizures, and, in severe cases, even death. Blood levels of bismuth, greater than 50 mg/L, are considered in the toxic range. The condition usually is reversible however, extremely prolonged use can result in permanent tremors.
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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.
Antagonism Of Central Muscarinic Acetylcholine Receptors
Impaired cholinergic neurotransmission has been implicated in the pathogenesis of delirium, mild cognitive impairment, Alzheimer disease, and dementia with Lewy bodies.29 Individuals with already reduced central cholinergic activity, such as elderly people or those with baseline dementia, are at increased risk for cognitive complications due to the use of anticholinergic medications.2,4,6,30,31 Antagonism of the central muscarinic receptors can result in problems with attention and delirium2 as well as chronic cognitive deficits.6,32 A longitudinal cohort study of individuals 60 years and older without senile dementia at recruitment who were followed for 2 years reported that consistent use of anticholinergic medications was associated with poorer cognitive performance in a variety of cognitive performance domains: attention , simple reaction speed , primary and secondary visuospatial memory , narrative recall , and language tasks . Implicit memory and logical reasoning were unaffected. Pursuant to these findings, it was suggested that consistent use of anticholinergic drugs was a strong predictor of mild cognitive impairment compared with nonusers.6 Medications in this study with various anticholinergic effects included drugs used in psychiatry , cardiology , neurology , pneumology , and urology , and also those medications with analgesic and anti-inflammatory effects .
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University Of Washington School Of Pharmacy
The UW School of Pharmacy is committed to educating the next generation of leaders in pharmacy, pharmaceutical research, and health carewhile seeking to ensure the safe, rational, and cost-effective use of medicines. Founded in 1894, the UW School of Pharmacy is ranked #3 in the world according to Shanghai Jiao Tong University. Follow the School of Pharmacy on or .
Effects Of Alcohol On The Brain
Many individuals consume a high amount of alcohol as it works as a depressant on the brain, slowing and dampening the nervous system. The brain suddenly stops processing the information as quickly as it used to, responses arent as logical, daily functions that you used to perform without thinking are now becoming a challenging task to complete, and inhibitions are being suppressed.
Individuals who drink heavily for years are more likely to have a reduced volume of the brains white matter, a chemical function that helps transmit signals between a variety of brain regions, this is ultimately the start of brain damage. Long-term, frequent alcohol consumption can also lead to a lack of vital vitamins such as thiamine B1 this deficiency can result in a disease called Korsakoffs syndrome, a memory disorder that affects only short-term memory loss.
Excessive drinking can result in significant risks regarding cognitive deficits and long-term brain damage. The heavier and more prolonged the individual has been drinking, the higher the risk of irreparable alcohol-induced dementia. According to the CDC, Alcohol is one of the most abused substances in the US. According to the Centres for Disease Control and Prevention, there is an average of 88,000 deaths each year related to binge drinking, heavy drinking, and other forms of alcohol use disorder.
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A Fifth Type Of Medication That Affects Brain Function
Opiate pain medications. Unlike the other drugs mentioned above, opiates are not on the Beers list of medications that older adults should avoid. That said, they do seem to dampen thinking abilities a bit, even in long-term users. As far as I know, opiates are not thought to accelerate long-term cognitive decline.
- Commonly prescribed opiates include hydrocodone, oxycodone, morphine, codeine, methadone, hydromorphone, and fentanyl.
- Tramadol is a weaker opiate with weaker prescribing controls.
- Many geriatricians consider it more problematic than the classic Schedule II opiates listed above, as it interacts with a lot of medications and still affects brain function. Its a dirty drug, as one of my friends likes to say.
Sleep Apnea And Related Deficits
Sleep disturbances, including insomnia and sleep apnea, are common as people age and may lead to reduced cognitive performance, mimicking signs of dementia. Lack of restful sleep can increase the risk of sleep-disordered breathing, decrease total sleep duration, and impair circadian cycles. A study by Hung and colleagues indicates that primary insomnia is associated with a two- to three-fold increased risk for developing dementia.
Sleep apnea is known to cause neuron hypoxia and increase the risk of vascular conditions, such as vascular dementia and stroke, which can increase the risk for dementia. Poor sleep quality and quantity can affect neuron health by interfering with the brains natural processes for clearing toxins, which can increase glial cell inflammation and oxidative neurotoxin accumulation. The result can be neuron damage, dementia pathology in the brain, and subsequent dementia-like symptoms.
Diagnostic testing
To determine whether a patient with a sleep disturbance has dementia or depression, their sleep patterns should be assessed with a sleep study. The study will help determine if the patient has obstructive sleep apnea, but it wont be able to differentiate a sleep disturbance resulting from dementia or depression. These will require complex testing and may still be inconclusive.
Treatment
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Research On Reversing Dementia
A study published in the journal Molecular Neurobiology looked at decreasing Tau protein levels in mice. Tau is one of the primary actors in the development of Alzheimers and has been something that scientists have been keen to manipulate in recent years.
The researchers looked closely at leukotriene levels in themice, a family of inflammatory mediators produced in leukocytes by theoxidation of chemicals within the brain. During the early stages of dementia,leukotrienes attempt to protect nerve cells, but as the condition progresses,they actually cause them damage.
In an attempt to stop the leukotrienes from doing this damage,the researchers gave mice a drug called zileuton, which inhibits leukotrieneformation by blocking enzymes that cause it to form. The results were promising, with micethat were treated with the drug for 16 weeks performing significantly better ontests designed to examine memory and tasks related to spatial learning thanthose who didnt receive the treatment.
Further examination revealed that the treated mice had seena 50% reduction in tau protein levels and had a higher level of integrity intheir synaptic connections.
The belief that dementia can be reversed is leading to newresearch and new groups dedicated to taking it on. The ReCODE program is a treatment approach based on addressing themechanisms responsible for the expression of Alzheimers disease. Its anapproach that aligns with the principles of integrative and functionalmedicine.
What Is Dementia From Toxic Substances
Dementia originated from toxic substances is a form of degenerative dementia, rooted in the ingestion of or exposure to heavy metals or carbon monoxide. Commonly referred to as toxic encephalopathy, the exposure to toxic substances can deteriorate an individual’s mental capabilitiesâeither acutely or chronicallyâand lead to full-on dementia.
Toxic encephalopathy is a general term used to describe any sort of cerebral damage that comes from the use of or exposure to toxic compounds, chemicals or metals. This damage is sometimes reparable, but in cases in which the damage persists, the risk for development of degenerative dementia skyrockets.
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