These Common Drugs May Increase Dementia Risk
A common class of drugs that doctors prescribe for a number of conditions from bladder problems to Parkinsons disease and depression may increase a persons risk of dementia, a large new study concludes.
New research by scientists from the University of Nottingham in the United Kingdom has analyzed the link between a certain class of drugs and the risk of dementia.
The drugs in question, called anticholinergics, work by inhibiting a chemical messenger called acetylcholine.
Their effect is to help relax or contract muscles, and doctors can prescribe them to help treat bladder conditions, gastrointestinal problems, and some of the symptoms of Parkinsons disease.
In their new study, which looked at data from tens of thousands of participants, the researchers concluded that anticholinergics may increase a persons risk of developing dementia.
The National Institute for Health Research funded this study, and the scientists published their findings yesterday in
If You Take One Of These Drugs
It’s always good to review the potential benefits and harms of these medications with your doctor. If a drug appears problematic, the two of you can explore alternatives by considering the reason it was prescribed and seeing if there is a different type of drug that can be used as a replacement.
Don’t stop taking the drugs on your own. It isn’t safe to quit most benzodiazepines and anticholinergic drugs “cold turkey.” Work with your clinician to develop a plan for tapering off them.
Common Medications Linked To Dementia Risk
Long-term use of certain drugs, some of them used to treat depression, has been linked to an increase in dementia risk in a study that looked at 27 million medications and their effects on 40,000 people with dementia compared to 283,000 without the disease.
Researchers at the University of East Anglia in the U.K. found that one type of drugcalled anticholinergic drugs, which treat depression, Parkinsons disease and loss of bladder controlincreased a persons risk of developing dementia by up to 30 percent. Anticholinergic drugs work by blocking acetylcholine, a nervous system neurotransmitter that carries brain signals that control muscles.
The study looked into a link that had been previously established with this particular type of drug, said study authors. They also found that taking the drug even decades before could still heighten risk of dementia. This study is large enough to evaluate the long-term effect and determine that harm may be experienced years before a diagnosis of dementia is made, said co-author Noll Campbell, Regenstrief Institute and Indiana University Center for Aging Research investigator.
In the past, researchers found that the risk was still present when the drugs were taken up to 20 years prior to their investigation.
This study found that long-term use of some types of anticholinergic drugs increased dementia risk, but not others, like antihistamines and those used for abdominal cramps.
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Q Is There Any Evidence That Anticholinergic Drugs Increase Your Risk For Dementia
A. There is evidence that certain medications both prescription and over-the-counter are associated with an increased risk of dementia. The latest study to confirm this connection came out in June 2019 in the Journal of the American Medical Association . This large, robust study showed a definite link between anticholinergic medications and patients who have dementia, but it didnt prove that there was a direct cause.
Given the known increased risk of dementia with certainmedications, we try to get patients off of these medications, if possible. Wehave seen patients cognition improve as a result.
Anticholinergic Drugs Can Increase Dementia Risk By 54%
Seniors who dont have Alzheimers or dementia still need to be careful of anticholinergic medications.
Thats because these drugs can increase the risk of developing dementia in the future.
A study of adults aged 65+ found that those who took an anticholinergic drug for three or more years had a 54% higher dementia risk.
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Known Risks Of Prescribing Drugs Not Approved For Dementia Treatment To Dementia Patients
None of the drug classes studied has received U.S. Food and Drug Administration approval for use in dementia, and Maust says that evidence for their off-label use is slim.
But all of the drugs are associated with special risks to people in their 60s and older, including falls or dependence that could lead to withdrawal. Most are included on the list known as the Beers criteria, which identifies medications with extra risks for all older adults, not just those with dementia.
While there is limited evidence that antidepressants help people with dementia, Maust notes that someone who had depression before they developed dementia might benefit from staying on a drug that worked for them in the past.
And while there is little evidence of benefit, all these medications have side effects. For example, some people starting a new antidepressant can experience nausea or feel a little jittery. Unfortunately, a person with dementia might have difficulty articulating such side effects to the loved one who takes care of them. Instead, they may appear more agitated leading to another prescription medication to calm them.
While the current study doesnt look at polypharmacy the use of multiple psychoactive drugs by the same patient Maust is exploring this issue further in the Medicare data.
Selective Benzodiazepine Drugs Enhance P
Selective prescription benzodiazepines are p-tau aggregation enhancers . Net changes of ThS fluorescence from p-tau aggregation under the influence of 6.25, 12.5, 25, 50, 100 and 150 µM of benzodiazepines. Prednicarbate, a synthetic steroid, served as a PTAE control . Benzodiazepine and prednicarbate did not elevate ThS fluorescence without p-tau. Shown are net changes of ThS fluorescence after 16 h of incubation with 150 µM of each of the indicated compounds, indicated by the first three letters of each compound.
Enhanced cytotoxicity of p-tau by benzodiazepines with the PTAE activity. SH-SY5Y cells were treated with 00.6 µM of p-tau in conjunction with varying doses of nitrazepam, prazepam or devazepide. Devazepide consistently showed stronger exacerbation on p-tau cytotoxicity, hence lower concentrations were used here. The red dotted lines indicate 50% viability. Curve fitting was done with the doseresponse fitting function of the software Origin . The number in parentheses represents the concentration of the indicated compound.
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What Prescription Drugs Are Linked To Alzheimer’s
. Hereof, can certain medications cause Alzheimer’s?
MONDAY, June 24, 2019 — Doctors often prescribe anticholinergic drugs for a variety of ills. But a new study suggests they may increase the risk of dementia in older patients. These medicines include everything from Benadryl to certain antipsychotics and Parkinson’s meds.
One may also ask, what medications make dementia worse? Medications: Some Drugs Make Dementia Worse
- Benadryl, found in cough syrups and over-the-counter allergy and sleeping pills such as Tylenol PM®.
- Bladder pills such as Tolterodine/Detrol®, Oxybutynin/Ditropan.
- Tropsium/Sanctura®, do help when patients need to urinate often.
Beside this, what are the 9 drugs linked to Alzheimer’s disease?
The researchers found no significant increases in dementia risk associated with antihistamines, skeletal muscle relaxants, gastrointestinal antispasmodics, antiarrhythmics, or antimuscarinic bronchodilators, but associations were found among other classes of anticholinergic drugs.
What antidepressant should not be prescribed for patients with Alzheimer disease?
Citalopram, escitalopram, and sertraline are often used. Paroxetine is another often-used SSRI, but as it is much more anticholinergic than the other SSRIs, geriatricians would avoid this medication in a person with dementia.
What Are Antipsychotic Drugs
Antipsychotic drugs are used to treat people who are experiencing severe agitation, aggression or distress from psychotic symptoms, such as hallucinations and delusions. They tend to be used only as a last resort, such as when the person, or those around them, are at immediate risk of harm.
For some people, antipsychotics can help to reduce the frequency or intensity of these changes. However, they also have serious risks and side effects, which the doctor must consider when deciding whether to prescribe them.
The first prescription of an antipsychotic should only be done by a specialist doctor. This is usually an old-age psychiatrist, geriatrician or GP with a special interest in dementia.
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New Research Links Certain Medications To Dementia Risk
A new study raises the possibility that certain medications may contribute to the risk of developing dementia.
The focus of this study was on medications with “anticholinergic” effects. These are drugs that block a chemical messenger called acetylcholine, which affects muscle activity in the digestive and urinary tracts, lungs, and elsewhere in the body. Its also involved in memory and learning.
Many medications have at least some anticholinergic effects, and its estimated that up to half of older adults in the US take one or more of these medications. Common examples include:
- amitriptyline, paroxetine, and bupropion
- oxybutynin and tolterodine
- diphenhydramine .
In this new study, researchers collected detailed information from more than 300,000 adults ages 65 and older, and compared medication use among those diagnosed with dementia with those who were not. Those who had taken any medication with anticholinergic activity were 11% more likely to be eventually diagnosed with dementia for those drugs with the most anticholinergic effects, the risk of dementia was 30% greater. The largest impact was found for drugs commonly taken for depression, bladder problems, and Parkinsons disease for antihistamines, and some other anticholinergic drugs, no increased risk of dementia was observed.
Antipsychotics And Other Drug Approaches In Dementia Care
Antipsychotic drugs may be prescribed for people with dementia who develop changes such as aggression and psychosis. However this is usually only after other drugs have been tried such as anti-depressant, anti-dementia and anticonvulsant drugs.
Drugs for behavioural and psychological symptoms
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Which Common Medications Are Linked To Dementia
Emily Hong & Meg Seymour, PhD
You may have heard the media coverage that common medications may increase the risk for dementia. These medications include a variety of drugs, including antihistamines , some antidepressants, and drugs that help people with Parkinsons.1 What do these drugs all have in common, what do you need to know about them, and are there really risks to taking them?
The drugs in question are called anticholinergic medications. They block the action of a neurotransmitter called acetylcholine. Acetylcholine is important for memory, attention, and learning. Because of this connection to memory and the brain, the side effects of some anticholinergic drugs can include dementia-like symptoms, such as memory loss and confusion.
In most cases, these side effects go away after people stop taking the medications.2 However, people taking some anticholinergic drugs may have an increased risk of developing dementia later.2, 3, 4 It is important to note that there are many types of anticholinergic drugs that treat many conditions. The risk may be specific to some drugs. So, its important to assess each type of anticholinergic drug separately.
A 2019 study conducted in England included 284,343 patients.4 It looked at 56 different anticholinergic drugs to see their effects on risk for dementia. The study found that people had a higher risk for dementia if they took:
Cholinesterase Inhibitors And Other Drugs
The new generation of cholinesterase inhibitor drugs were originally developed to improve memory and the ability to carry out day-to-day living activities in people with Alzheimers disease.
Evidence suggests that these drugs also have slight beneficial effects on behavioural symptoms, particularly apathy , mood and confidence, delusions and hallucinations. Taking cholinesterase inhibitor drugs may therefore reduce the need for other forms of medication. However, in higher doses these cholinesterase inhibitor drugs may occasionally increase agitation and produce insomnia with nightmares.
Memantine is the most recent antidementia drug to be developed. It works in a different way to the anticholinesterase drugs and is the first drug approved for those in the middle to later stages of Alzheimers disease.
There is some evidence that memantine has a positive effect on mood, behaviour and agitation.
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Treatment For Mild To Moderate Alzheimers
Treating the symptoms of Alzheimers can provide people with comfort, dignity, and independence for a longer period of time and can encourage and assist their caregivers as well. Galantamine, rivastigmine, and donepezil are cholinesterase inhibitors that are prescribed for mild to moderate Alzheimers symptoms. These drugs may help reduce or control some cognitive and behavioral symptoms.
Scientists do not yet fully understand how cholinesterase inhibitors work to treat Alzheimers disease, but research indicates that they prevent the breakdown of acetylcholine, a brain chemical believed to be important for memory and thinking. As Alzheimers progresses, the brain produces less and less acetylcholine, so these medicines may eventually lose their effect. Because cholinesterase inhibitors work in a similar way, switching from one to another may not produce significantly different results, but a person living with Alzheimers may respond better to one drug versus another.
Before prescribing aducanumab, doctors may require PET scans or an analysis of cerebrospinal fluid to evaluate whether amyloid deposits are present in the brain. This can help doctors make an accurate diagnosis of Alzheimers before prescribing the medication. Once a person is on aducanumab, their doctor or specialist may require routine MRIs to monitor for side effects such as brain swelling or bleeding in the brain.
What To Do If You Or Your Relative Is On These Medications
So what should you do if you discover that your older relative or you yourself are taking some of these medications?
If its an over-the-counter anticholinergic, you can just stop it. Allergies can be treated with non-sedating antihistamines like loratadine , or you can ask the doctor about a nasal steroid spray. PM painkillers can be replaced by the non-PM version, and remember that the safest OTC analgesic for older adults is acetaminophen .
If you are taking an over-the-counter sleep aid, it contains a sedating antihistamine and those are strongly anticholinergic. You can just stop an OTC sleep aid, but in the short term, insomnia often gets worse. So youll need to address the insomnia with non-drug techniques.
You should also discuss any insomnia or sleep problems with your doctors its important to rule out pain and serious medical problems as a cause of insomnia but be careful: many of them will prescribe a sleeping pill, because they havent trained in geriatrics and they under-estimate the risks of these drugs.
If one or more of the medications above has been prescribed, dont stop without first consulting with a health professional. Youll want to make an appointment soon, to review the reasons that the medication was prescribed, alternative options for treating the problem, and then work out a plan to reduce or eliminate the drug.
Now go check out those medication bottles, and let me know what you find!
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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.
Fdas Accelerated Approval Program
Aducanumab was approved through the FDAs Accelerated Approval Program, which provides a path for earlier approval of drugs that treat certain serious conditions. This helps people living with the disease gain earlier access to the treatment. The approval of aducanumab was based on the ability of the drug to reduce amyloid in the brain. When using the accelerated approval pathway, drug companies are required to conduct additional studies to determine whether there is in fact clinical benefit after the drug is approved. If the follow-up trial fails to verify clinical benefit, the FDA may withdraw approval of the drug. Results of the phase 4 clinical trial for aducanumab are expected to be available by early 2030.
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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.