Common Medications That May Increase Your Dementia Risk According To A Pharmacist
Much is still unknown about dementia. Do genetics contribute to your risk? And how do lifestyle choices impact your chances of developing this condition, which affects more than 55 million people worldwide? While researchers are still studying these factorsand searching for a curethere’s evidence that certain medications may play a role in cognitive decline, particularly in older patients.
Robert Alesiani, PharmD, chief pharmacotherapy officer at Tabula Rasa HealthCare, explains that “medications can have side effects, and those side effects bring on more medications to treat the side effectsit’s just a growing cascade of medication.” Read on to see which common medications he says may increase your risk of dementia.
When Im Sixty Four
Nearly 40 years ago, The Beatles launched a famous song which included the words Will you still need me, will you still feed me when Im 64. At that time Paul McCartney, looking at his 64 year old father, wondered how life would be at 64considered old at that time apparentlyprobably also being afraid for age related diseases, such as dementia. In the coming decades, the financial and emotional burden placed by dementia on the working age population will rise notably. As the age distribution of the western population shifts, the rapid increase of the prevalence of dementia with increasing age means that both the number of affected individuals and the affected proportion of the total population are increasing. This will be especially prominent in Europe, where the median age of the population is higher than in all other parts of the world. Based on several meta-analyses of epidemiological studies and the population projections of the United Nations, the number of prevalent cases in Europe in the year 2000 was about seven million. Within the next 50 years, this number is estimated to more than double to well over 16 million patients with dementia. Not only will the number of patients with dementia increase in the same time span, the working age population will considerably decrease in number . While in the year 2000, there was a ratio of 69 working age persons to one demented person, this ratio will decrease to 21:1 in 2050.
Figure 4
Your Brain Is Your Most Valuable Asset
Being brain healthy is relevant at any age, whether you are young, old or in between. However, it is particularly important once you reach middle age as this is when changes start to occur in the brain.
The risk factors for dementia are different in everybody.
Your potential for developing dementia may be influenced by:
Non-modifiable risk factors are risks that cannot be changed, such as:
- age as you age, your risk of developing dementia increases
- genetics there are a few very rare forms of dementia associated with specific genes
- family history a family history of dementia increases your risk of developing dementia but at this stage it is not clear why.
Modifiable risk factors are risks that can be changed through lifestyle choices. You can reduce your risk of dementia by looking after your:
Whilst we cannot change getting older, genetics or family history, scientific research suggests that changing certain health and lifestyle habits may make a big difference to reducing or delaying your risk of developing dementia.
Its never too early or too late to start.
Learn more about how to reduce the risk of dementia and explore our risk reduction resources.
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Genetic And Lifestyle Risk Factors
The short answer is that the risk of developing dementia is related to a combination of genetics and lifestyle, with age being the biggest risk factor.
In most cases, genetic risk factors come from small influences of many genes, rather than one mutation being responsible for the entire genetic effect. Therefore, it is unlikely that a child will inherit every dementia-related mutation that a parent has.
Impact On Families And Carers
In 2019, informal carers spent on average 5 hours per day providing care for people living with dementia. This can be overwhelming . Physical, emotional and financial pressures can cause great stress tofamilies and carers, and support is required from the health, social, financial and legal systems. Fifty percent of the global cost of dementia is attributed to informal care.
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Disproportionate Impact On Women
Globally, dementia has a disproportionate impact on women. Sixty-five percent of total deaths due to dementia are women, and disability-adjusted life years due to dementia are roughly 60% higher in women than in men. Additionally, women providethe majority of informal care for people living with dementia, accounting for 70% of carer hours.
Dementia With Young Onset
Most studies on prevalence of dementia focus on subjects aged over 65 years. Although age is well established as its most important risk factor, dementia may also affect people under the age of 65. Few data exist on the prevalence of dementia in younger people. A recent study in the UK was designed to determine the prevalence of dementia in people under the age of 65 in a large catchment area and use these figures to estimate the number of younger people affected by dementia in the UK. The prevalence of dementia in those aged 3064 was 54 per 100 000. For those aged 4564, the prevalence was 98 per 100 000. Like the studies mentioned above describing prevalence over the age of 65, there was a strong age dependency: from the age of 35 years onwards, the prevalence of dementia approximately doubled with every five year increase in age. In contrast with studies describing populations over 65, males seem at a higher risk to become demented before they reach the age of 65 than females.
Causes of dementia with young onset . Based on Harvey et al.
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Advice For Managing Blood Pressure
When asked how patients can manage and monitor their blood pressure levels, Dr. Patel highlighted that we need to be mindful regarding using these blood pressure recommendations for all patients.
The research study, for example, did not include those with diabetes and was mostly compromised of men. Risks and benefits of adding additional medication to further lower the blood pressure should be reviewed on a case-by-case basis, he said.
Dr. Tadwalkar noted the importance of lifestyle factors, telling MNT that his best advice is to vary the types of activity one does.
By performing a wide mix of exercises or activities, including those that are cardio-focused, weight-bearing in nature, balance or posture-related, mentally demanding, and those that are concerned with spiritual and emotional-centeredness, one can truly attain total body benefits. This includes less stress, greater mental clarity, better body mass index, lower cholesterol, improved glucose tolerance, and of course, more ideal blood pressure values. Dr. Rigved V. Tadwalkar
Other aspects certainly play a role, including:
- a healthy diet that emphasizes whole grains, lean or vegetarian sources of protein, healthy fats, as well as fruits and vegetables
- minimizing alcohol use
- ensuring adequate amounts of sleep
Dr. Patel agreed, saying the first line of treatment should include lifestyle modifications such as exercise, weight loss, diet, and tobacco use.
Risk Factors For Dementia
Researchers have identified several risk factors that affect the likelihood of developing one or more kinds of dementia. Some of these factors are modifiable, while others are not.
Age. The risk of Alzheimer’s disease, vascular dementia, and several other dementias goes up significantly with advancing age.
Genetics/family history. Researchers have discovered a number of genes that increase the risk of developing Alzheimer’s disease. Although people with a family history of Alzheimer’s disease are generally considered to be at a heightened risk of developing the disease themselves, many people who have relatives with Alzheimer’s disease never develop the disease, and many without a family history of the disease do get it.
In most cases, it is impossible to predict a specific person’s risk of the disorder based on family history alone. Some families with Creutzfeldt-Jakob disease, Gerstmann-Sträussler-Scheinker syndrome, or fatal familial insomnia have mutations in the prion protein gene, although these disorders can also occur in people without the gene mutation. Individuals with these mutations are at significantly higher risk of developing these forms of dementia.
Abnormal genes are also clearly implicated as risk factors in Huntington’s disease, FTDP-17, and several other kinds of dementia.
Many people with Down’s syndrome show neurological and behavioral signs of Alzheimer’s disease by the time they reach middle age.
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What Are The 12 Preventable And Modifiable Risk Factors For Dementia
Many of the risk factors that increase the likelihood of developing Alzheimers and dementia can be prevented by living a healthy lifestyle.
Being addicted to alcohol can lead to other risk factors such as overeating, engaging in risky behavior, and smoking cigarettes, which all contribute to an increased risk of dementia.
Lets review the 12 things to do to help prevent dementia.
Pathophysiology Of Alzheimers Disease
The presence of extracellular plaques of insoluble -amyloid peptide and neurofibrillary tangles of P-tau in neuronal cytoplasm is the hallmark of AD . Although the mechanisms by which these changes lead to cognitive decline are still debated, these deposits are believed to lead to atrophy and death of neurons resulting from excitotoxicity processes , collapse in calcium homeostasis, inflammation and depletion of energy and neuronal factors. As a result of this process, damage to neurons and synapses involved in memory processes, learning and other cognitive functions lead to the aforementioned cognitive decline .
According to amyloid cascade theory , the cerebral accumulation of A peptide, resulting from the imbalance between production and clearance of this protein, is the main event causing the disease, being other events observed resulting from this process .
The A peptide, which has 36 to 43 aminoacids, is derived from amyloid precursor protein enzymatic proteolysis, a physiologically produced protein that plays important roles in brain homeostasis . The APP gene is located on chromosome 21, which explains the higher incidence of early-onset AD in individuals with 21 trisomy and in individuals with APP gene locus duplication . It is believed that overexpression of APP results in an increase of cerebral A peptide, and consequently, in its deposition .
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Potential Risk Factors For Dementia During Midlife
During midlife , there are five potentially modifiable risk factors associated with dementia development: hearing loss, traumatic brain injury , hypertension, excessive alcohol consumption, and obesity.
- Hearing loss: Hearing loss is believed to account for 8% of worldwide dementia cases, making it the largest known potential modifiable risk factor for dementia. Noise-induced hearing loss is a preventable, and in most cases, treatable condition. Studies have also correlated the use of hearing aids in hearing-impaired individuals with reduced dementia risk.
- TBI: Single, severe TBIwhere severe TBI is defined as skull fracture, edema, brain injury, or bleedinghas been linked to widespread hyperphosphorylated tau pathology in both human and animal studies. Consequently, TBI has been linked to Alzheimers disease, the most common cause of dementia. TBI is believed to account for 3% of global dementia cases.
TBI is most commonly caused by falls, motor vehicle crashes, and recreational sports. Taking appropriate safety precautions, such as wearing seatbelts and appropriate headgear, can reduce the risk of TBI.
Physical Inactivity Exercise And Fitness
Studies of physical activity are complex. Patterns of physical activity change with age, generation, and morbidity and are different across sex, social class, and cultures. The studies suggest a complicated relationship with the potential for both risk reduction and reverse causation.
Meta-analyses of longitudinal observational studies of 121 years duration showed exercise to be associated with reduced risk of dementia.2 A further overview of systematic reviews concluded that there is convincing evidence for physical activity protecting against clinically diagnosed Alzheimer’s disease.88
Since the 2017 Commission, the HUNT study of 28916 participants aged 3060 years has been published, reinforcing the previous literature in this area. At least weekly midlife moderate-to-vigorous physical activity was associated with reduced dementia risk over a 25-year period of follow-up but the confidence intervals were wide.89 In contrast the Whitehall Study reporting on the 28-year follow-up of 10308 people, found that more than 2·5 hours of self-reported moderate-to-vigorous physical activity per week, lowered dementia risk over 10, but not 28 years.33 Very long-term studies are unusual however, one 44-year study recruited 191 women purposively to be representative of the Swedish population and reported that 32% of the participants with low baseline peak fitness, 25% with medium, and 5% with high fitness developed dementia .90
Trials of exercise
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Dementia Risk Factors And Prevention Dementia Risk Factors And Prevention
Some things can increase your risk of getting dementia, including your age, genes and lifestyle. There are also ways you can reduce your risk.
Learn more about alternative therapiesLearn more about alternative therapies .
Some alternative therapies, like cannabis oil , might benefit people with dementia. They work by treating the conditions related to dementia, such as sleep problems or agitation. However there are alleged alternative therapies, like coconut oil, that don’t help or are harmful.
How Managing Hypertension May Help
Five experts, who were not involved in this research, explained the findings and implications for patients to Medical News Today.
Dr. Anjali N Patel, DO, a fellowship-trained cognitive neurologist at the Atlantic Neuroscience Institute at Overlook Medical Center said that the SPRINT trial evaluated older adults with hypertension and one other cardiovascular risk factor such as chronic kidney disease, to determine if lowering the systolic blood pressure to 120mm Hg instead of 140mm Hg provided any benefits.
Overall, researchers found the participants had fewer heart attacks, strokes, and cardiac deaths. In reviewing the data further, researchers found lowering the target range of the blood pressure for prolonged period was associated with a lower risk of probable dementia, she told MNT.
However, Dr. Patel pointed out that in those with atrial fibrillation and hypertension, a lower target blood pressure range may increase the risk of probable dementia.
She said that, for people with hypertension, primary care physicians or cardiologists should work as a team to lay out the best goals of care tailored to the individual.
This is an important study that shows certain patients with cardiovascular risk factors can benefit from more aggressive control of their blood pressure. For example, in individuals with risk of developing a dementia disorder better management of their blood pressure may be beneficial. Dr. Anjali N Patel
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Biomarkers And Detection Of Alzheimer’s Disease
Markers of neurodegeneration linked to clinical dementia include brain volume lossie, hippocampal volume loss and entorhinal cortex and medial temporal cortical thinningseen in structural imaging. The most studied molecular markers are in Alzheimer’s disease and are amyloid and tau, which PET and CSF detect clinically. The prevalence of particular pathologies at different ages is important in interpretation of such studies. So, for example, population derived studies show increases in plaques in the population from less than 3% at age 5059 years to around 40% at age 8089 years.182
Amyloid imaging
Similarly, an 8-year follow-up study of 599 volunteers in Australia found that cognitively normal PET amyloid-positive people had an elevated risk of developing Alzheimer’s disease compared with amyloid negative .184 Over 80% of the 266 people who were PET amyloid-positive did not go onto develop a cognitive impairment within 8 years, showing positive status does not predict impairment for most people in a timeframe that might be a useful prognostic window. Follow-up at 5 years of amyloid-positive participants with normal cognition or mild cognitive impairment versus amyloid negative people found the same pattern of increased risk . Risk also increases per 1 year of age , and APOE4 status .184
Availability Of Data And Materials
The study used data from the Sixth National Health Services Survey in Jiangxi, the raw case data is closed to public access because it involves sensitive information of the survey respondents, but various statistical on the raw data are publicly available, for details, please refer to the book, An Analysis Report of National Health Services Survey in China, 2018 . We obtained administrative permission to access and use the raw data.
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Age: The Biggest Risk For Dementia
Age is the greatest risk factor for developing dementia. As with our genes, we unfortunately cant do anything to overcome ageing! However, there are environmental factors that seem to influence the likelihood of dementia and could account for about one-third of the overall risk of developing dementia. There is some evidence to suggest we can take steps to lessen the impact of these factors.
Data source: NATSEM calculations using ABS population projections
Have An Nhs Health Check
An NHS Health Check is a free check-up of your overall health for people aged 40 to 74 who do not have heart disease, diabetes or kidney disease, and have not had a stroke. It’s offered every 5 years.
The NHS Health Check can help find early signs and tell you if you’re at higher risk of certain health problems that can also increase your risk of dementia. These include:
If you’re over age 65, you’ll be told the signs and symptoms of dementia to look out for. You’ll also be given advice on how to lower your risk of dementia.
If you have not been invited for an NHS Health Check, ask your GP surgery.
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Lower Blood Pressure And Hypertension
Hypertension is the leading cause of strokes, which are small brain bleeds that negatively impact the brains ability to function.
Strokes are an established risk factor for many causes of dementia, with one-quarter to one-third of strokes resulting in dementia, known as stroke-related dementia. Make the healthy lifestyle changes needed to lower your blood pressure, mainly changing to a healthy diet such as the DASH diet or Mediterranean diet.