What Medications Make Dementia Worse
Many of us are familiar with what dementia is, or at the very least, have heard the term. The medical model of dementia perceives it as a symptom of various brain diseases, characterised by losing the ability to memorise or remember things. In severe cases, there are significant behavioural changes and the patient may be unable to perform the simplest of the tasks.
However, dementia can be cured with the correct medication, and several medication classes for dementia as well as medical interventions for dementia exist.
While dementia medication in the UK works to treat dementia, and medication aids for dementia and are widely prescribed as medications to treat dementia, some routinely used non-dementia medications can aggravate dementia if not taken carefully. We will here discuss how commonly used medications affect individuals with dementia. Before we move forward, a little introduction to dementia is important.
What Are Anticholinergic Drugs
Drugs with anticholinergic properties can be problematic, especially for the elderly. Anticholinergic drugs block the action of the neurotransmitter acetylcholine. A neurotransmitter is a chemical released by nerve cells to send signals to other cells. Acetylcholine is involved in transmitting messages that affect muscle contractions in the body and learning and memory in the brain.
Drugs with anticholinergic properties have been used in medicine for many decades in the treatment of such diverse conditions as:
- surgery and anesthesia for muscle relaxation
- gastrointestinal disorders
- psychiatric disorders
Is Alzheimer’s Inherited From Mother Or Father
We all inherit a copy of some form of APOE from each parent. Those who inherit one copy of APOE-e4 from their mother or father have an increased risk of developing Alzheimer’s. Those who inherit two copies from their mother and father have an even higher risk, but not a certainty…. continue reading
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Why The Drugs Affect Your Mind
Both anticholinergics and benzodiazepines affect the activity of neurotransmitterschemical messengers that work in the central nervous systembut the drugs work in slightly different ways.
Anticholinergic drugs block the action of acetylcholine. In the brain, acetylcholine is involved in learning and memory. In the rest of the body, it stimulates the autonomic nervesthose that regulate contractions of blood vessels, airways, and our cardiovascular and digestive systems. The strongest anticholinergic drugs include some antihistamines, tricyclic antidepressants, medications to control overactive bladder, and sleeping pills.
Benzodiazepines boost another neurotransmitter’s effectiveness. They make gamma-aminobutyric acid which slows the activity of neurons in the brain-more potent. For that reason, they are used to calm anxiety and help people sleep.
Whats The Bottom Line
Its possible, but not proven, that some anticholinergic drugs increase the risk of dementia. If you need long-term treatment for one of the relevant medical conditions, talk to your doctor about other medication options that are not in the anticholinergic class, such as antidepressants like Celexa and Prozac. In many cases, there may be choices.
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Popular Drugs Linked To Dementia And Memory Loss
Any time you take a medication, weighing the risks and benefits of the drug is a must. And now we must ask ourselves, Is this one of the drugs linked to dementia and memory loss? Emerging research is finding disturbing connections between anticholinergic drugs and negative brain effects. This drug class includes popular medications used for allergies, seasickness and sleep, including diphenhydramine, dimenhydrinate and others.
And yes, youd think some of the most popular allergy and insomnia drugs on the market would be safe, but one study outlines some frightening health risks. The JAMA Neurology study is unique because Indiana University School of Medicine researchers actually used brain imaging to detect how anticholinergic drugs impact the brain. Using MRI and PET scan imaging, researchers showed how people taking anticholinergic drugs experienced lower brain metabolism and higher brain atrophy.
This isnt the first time researchers found a connection between anticholinergic drugs and cognitive decline. In 2015, University of Washington scientists also found the chronic use of certain anticholinergic sleep aids and hay fever meds in the increased a persons risk of dementia. The study only found the association for people taking these drugs for 3 or more years.
Common Medications Can Masquerade As Dementia In Seniors
By Judith GrahamJuly 18, 2019
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What Does Previous 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.
For example, a 2015 study by researchers at the University of Washington found that people age 65 and older who took these medications for three years or more had a 54 percent greater risk of developing dementia than people who took the medications for three months or less.
A 2014 review found more than 30 studies that suggested confusion and other symptoms of cognitive decline increase with the amount of anticholinergic medication someone takes.
Dr. Malaz Boustani, director of the Regenstrief Center for Health Innovation and Implementation Science at Indiana University, has created a tool called the anticholinergic cognitive burden scale, which ranks drugs by their suspected effects on cognition. Experts suggest avoiding extended use of drugs with a rating of 3 on the scale or combinations of drugs that together rate 3 or higher.
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.
Older adults are more likely to be prescribed many of these medications, simply because they tend to have more health issues. Some experts say that because people produce less acetylcholine as they age, drugs that inhibit that neurochemical can have a stronger effect on older people.
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Implications For Clinicians And Policymakers
The associations reported here are moderate , but given the high incidence of dementia they reflect an appreciable risk to patients. For example, the odds ratio for dementia associated with any use of antidepressants with an ACB score of 3 15-20 years before the index date is 1.19 . A typical patient aged 65-70 might normally expect a period incidence of dementia of around 10% over the next 15 years,36 so this odds ratio would be consistent with an absolute risk increase of 2% over that period, corresponding to a number needed to harm of 50 . Possible explanations for our findings are that other actions of specific groups of anticholinergic drugs may underlie observed effects, or that the drugs are markers of prodromal symptoms or dementia risk factors. Alternatively, the class specific association we have observed may reflect a difference in the ability of different groups of anticholinergics to cross the blood-brain barrier.
Anticholinergic urological drugs, particularly oxybutynin, have been consistently associated with short term cognitive decline in randomised controlled trials,841 so a long term risk of dementia is plausible. Lower urinary tract symptoms themselves have been linked to future dementia incidence and may be a symptom of early neurodegeneration.4243 To account for our finding, urinary incontinence would need to be a substantial risk factor for dementia diagnosed 15-20 years later.
What Should You Do If You Take These Drugs
Keep in mind that the research shows associations and correlationsnot causation or definitive proof.
However, if you are an older person or have Alzheimers risk factors, its a good idea to talk with your doctor about your medications. Are there non-anticholinergic medications you can take instead? Do the benefits of your medication outweigh its risks? Perhaps you can revisit beneficial lifestyle habits to help control your symptoms.
Another question to ask is if you are taking the lowest possible effective dose. The researchers at the University of California in San Diego found that the older people in the study were taking much higher doses of anticholinergic drugs than recommended for their ages. The majority were taking double the recommended dosage and 18% were taking four times the optimal dose. One first step might be to find out if you are taking too high a dose another would be to see how many anticholinergic drugs you are taking to see your total intake.
A doctor in England has created an online tool, the Anticholinergic burden calculator, where you can plug in what drugs you are taking and see how they combine. If you have a score of three or higher on this calculator, you are considered at higher risk of developing cognitive impairment.
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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.
Risks Should Be Carefully Considered
To assess the strength of anticholinergic drugs and how often the participants took them, the team looked at available information about prescriptions over a period of 10 years.
However, they note that this is an observational study, so they cannot confirm whether the drugs are directly responsible for the increased risk of dementia.
The researchers add that doctors may have prescribed some of these drugs to their patients precisely for the treatment of very early dementia symptoms.
Nevertheless, Prof. Coupland argues that the study adds further evidence of the potential risks associated with strong anticholinergic drugs, particularly antidepressants, bladder antimuscarinic drugs, anti-Parkinsons drugs, and epilepsy drugs.
The risks of this type of medication should be carefully considered by healthcare professionals alongside the benefits when the drugs are prescribed and alternative treatments should be considered where possible.
Prof. Carol Coupland
These findings also highlight the importance of carrying out regular medication reviews.
We found a greater risk for people diagnosed with dementia before the age of 80, which indicates that anticholinergic drugs should be prescribed with caution in middle-aged people as well as in older people, she concludes.
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Medications Implicated In The Worsening Of Dementia Symptoms:
Now that you have a sound understanding of what dementia is, lets move forward to what medications can cause dementia. Heres a list of medications that may cause dementia:
1. Anticholinergic Drugs:
The first on our list are anticholinergic drugs, one of many medications that can cause dementia.
Mechanism of Action: This class of drugs is responsible for inhibiting the production/secretion of Acetylcholine, which is a neurotransmitter playing a significant role in regulating the tasks performed by the parasympathetic nervous system, such as learning, muscle movement, etc. The link between anticholinergic medications and dementia is well-established.
Alzheimers disease and dementia are also caused due to the deficiency of Acetylcholine. Administering drugs that further reduce the concentration of the neurotransmitter in the brain can be hazardous and may cause the disease to progress more rapidly. The adverse effects of acetylcholine medications in dementia are well-documented.
Commonly Used Anticholinergic Medications: It is important to know about the drugs classified as anticholinergic so they can be readily recognised if an individual exhibits behaviour that indicates dementia. A list of anticholinergic-medication that causes dementia is:
- Tri-cyclic Anti-depressants
- Over-the-counter drugs
- Parkinsons medication
Can Parkinsons medicine cause dementia? The answer is yes, Levodopa and Carbidopa are medications for Parkinsons causing dementia.
2. Benzodiazepines:
What The Studies Found
It’s important to note that neither of these studies was a randomized controlled clinical trial, so neither proved that either type of drug causes dementia.
The anticholinergic study. Researchers tracked nearly 3,500 men and women ages 65 or older who took part in Adult Changes in Thought , a long-term study conducted by the University of Washington and Group Health, a Seattle health care system. They used Group Health’s pharmacy records to determine all the drugs, both prescription and over-the-counter, that each participant took in the 10 years before starting the study. Participants’ health was tracked for an average of seven years. During that time, 800 of them developed dementia. When the researchers examined medication use, they found that people who used anticholinergic drugs were more likely to have developed dementia than those who didn’t 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 the drugs to alleviate early symptoms of undiagnosed dementia. For people who took anticholinergic bladder medications, the increased risk was just as high as for those taking tricyclic antidepressants, which are also anticholinergics.
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Drugs Linked To Increased Dementia Risk
At the moment, theres no proof that certain drugs cause dementia. However, there are two drug classes that are clearly tied to higher dementia risk. The American Geriatrics Society and a number of studies strongly recommend doctors avoid prescribing these drugs to older adults when possible.
Since causation hasnt been proven, theres also no proof that certain drugs make dementia worse on their own. However, some common dementia symptoms, like confusion and memory loss, are known side effects of these types of drugs and others.
How Does Dementia Progress
Dementia is not a disease itself but rather a symptom of multiple diseases, of which the most common is Alzheimers disease.
The brain is a complex structure that is responsible for regulating almost every single function of the body. Physical changes such as the buildup of proteins, low supply of red blood cells or alpha-synuclein clumps in the brain structure can impair cognitive function, leading to the development and progression of dementia. However, you can slow down dementia with medication.
Stages of Dementia:
Dementia is a progressive disease, which means once developed, it never stops advancing and continues to escalate in severity until the patients death. Research is currently underway to discover dementia prevention medication.
The symptoms and stages of dementia are:
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Can Gabapentin Cause Alzheimer’s
The greatest risk for Alzheimer’s and dementia was observed with valproate. In contrast, medications with no known cognitive adverse effects, which include oxcarbazepine, vigabatrin, tiagabine, lamotrigine, gabapentin, levetiracetam, pregabalin, and lacosamide, did not correlate with an increased dementia risk…. see details
Limiting Your Loved Ones Med
Your loved one may need to keep taking meds listed in this article. But their doctor may be able to deprescribe or replace these drugs and others on the list of potentially inappropriate medications for older adults from the American Geriatrics Society Beers Criteria.
If youre unsure about your loved ones exposure to these drugs, bring a bag of all their medications to their next appointment. Be sure to include any over-the-counter meds they take not just their prescriptions.
A geriatrician will be able to give age-related expertise on your loved ones medication regimen.
Want to learn more? Keep reading about other well-known drugs and their connection to dementia:
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Why These Drugs Have A Stronger Effect In Older People
As we age, our ability to process medication changes. The kidneys and liver clear drugs more slowly, so drug levels in the blood remain higher for a longer time. People also gain fat and lose muscle mass over time. Both these changes affect the way drugs are distributed to and broken down in body tissues. And because these drugs are stored in body fat, they can continue to produce effects days after people stop taking them, especially in people with a higher proportion of body fat. In addition, older people tend to take more prescription and over-the-counter medications, each of which has the potential to suppress or enhance the effects of the others.
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.
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