What Are Cholinesterase Inhibitors
If your loved one has Alzheimerâs disease that isnât too severe yet, their doctor might prescribe them a cholinesterase inhibitor. If they have another type of dementia, their doctor may consider it, too.
What they do: Scientists think these help prevent a âmessenger chemicalâ in our brains called acetylcholine from breaking down. Acetylcholine is important in learning, memory, and mood. Cholinesterase inhibitors also appear to delay the worsening of Alzheimerâs symptoms.
These medicines include:
What to expect: Most people with Alzheimerâs who take one of these medications get some benefit from it, including less anxiety, improved motivation, and better concentration and memory. And some are able to continue with their regular activities.
But the improvements donât seem to last long — about 6 to 12 months. They mainly delay the worsening of the disease for a period of time.
All three medicines work similarly, but one might work better for your loved one than it does for someone else.
Side effects: Most people donât have side effects when they take cholinesterase inhibitors, but some do have:
Drugs For Treating Anxiety
Anxiety states, accompanied by panic attacks and fearfulness may lead to demands for constant company and reassurance.
Short-lived periods of anxiety, for example in response to a stressful event, may be helped by a group of drugs known as benzodiazepines. Continuous treatment in excess of two to four weeks is not advisable because dependency can occur, making it difficult to stop the medication without withdrawal symptoms.
In addition, benzodiazepines are associated with a range of side-effects that make them particularly problematic for older people and should not be recommended other than for very short term use. Where an individual has used benzodiazepine drugs for a long period prior to the development of dementia withdrawal may be difficult, but the decision about whether to continue their use or to slowly reduce the dose should be addressed with the doctor treating the person with dementia.
There are many different benzodiazepines, some with a short duration of action, such as lorazepam and oxazepam, and some with longer action, such as chlordiazepoxide and diazepam. All of these drugs may cause excessive sedation, unsteadiness and a tendency to fall, and they may accentuate any confusion and memory deficits that are already present. The long term use of benzodiazepines for neuropsychiatric symptons is not recommended, but they have a limited role in the short term treatment of agitation in people with dementia .
What Kind Of Research Was This
This was a case-control study that looked at a large group of people with and without dementia and compared their use of anticholinergic drugs.
Anticholinergics are known to have side effects like confusion and memory loss in older adults, but it was not clear whether they could be linked to dementia.
Case controls are often used as it would be less feasible to identify a group of people using the drugs, along with a comparison group, and follow them in the long-term to see who developed dementia.
It is more practical to make use of the large quantity of data in the GP database to identify those with dementia and then look back at individuals’ prescribing history. The difficulty is you cannot account for all other factors that may be involved.
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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.
Bmj: Anticholinergic Drugs And Risk Of Dementia: Case
UK researchers have found a link between the long-term use of certain anticholinergic drugs and an increased risk of dementia. The findings are published in the British Medical Journal.
The researchers looked at drugs which have an anticholinergic action meaning they block the action of a brain chemical called acetylcholine, which is used to help nerve cells send signals to one another. Some of the symptomatic treatments for Alzheimers disease work by boosting levels of this chemical, and some previous research has linked the use of anticholinergic drugs to an increased risk of dementia
Researchers compared the medical records of over 40,000 people between the ages of 65 and 99 who received a dementia diagnosis, with over 280,000 people who did not develop dementia. They found that people who had been prescribed anticholinergic drugs to treat depression, urological conditions, or the symptoms of Parkinsons disease were slightly more likely to have developed dementia. They did not find any link between dementia risk and anticholinergic drugs that are used to treat other conditions such as allergies or stomach problems.
They found evidence for the link even if people had been using the drugs 15-20 years before being diagnosed with dementia, and after taking into account dementia risk factors, such as heart disease and diabetes. Researchers only included people in their analysis if they had been taking anticholinergic drugs for over a year.
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Prescription Drugs Linked To Increased Dementia Risk
Prescription drugs linked to increased dementia risk from Mercola
While the link between anticholinergic drugs and an increased risk of dementia isnt new, researchers have now pinpointed certain classes of drugs where the link is the strongest. In a study published in the journal JAMA Internal Medicine, researchers wrote there was nearly a 50% increased odds of dementia associated with a total anticholinergic exposure of more than 1,095 daily doses over a time period of 10 years. To put that into perspective, its the equivalent of an older adult taking a strong anticholinergic medication every day for at least three years.
Researchers analyzed data on 284,343 adults in the U.K., aged 55 and older, between 2004 and 2016. They identified each adults anticholinergic exposure based on their prescription details and found the most frequently prescribed anticholinergics were antidepressants, drugs to treat vertigo, motion sickness or vomiting and drugs to treat overactive bladder. They also found that 58,769 of the patients had been diagnosed with dementia. The study showed that compared to those who had not taken anticholinergic drugs, the chances of dementia increased from 1.06 among those with the lowest exposure to the drugs to 1.49 among those with the highest exposure.
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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Where Did The Story Come From
This study was conducted by researchers from the universities of Nottingham, Southampton and Oxford, and predominantly funded by the National Institute for Health Research, with additional funding from various other sources. The study was published in the peer-reviewed journal JAMA Internal Medicine and is freely available to access online.
The UK media’s reporting of the study was accurate, though most news sources led with the “increase risk of dementia by 50%” finding of the study. This finding was only seen for the maximum use of anticholinergics in terms of dosage and duration of use.
Commonly Prescribed Meds Could Raise Dementia Risk
MONDAY, June 24, 2019 — Doctors often prescribe anticholinergic drugs for a variety of ills. But a new study suggests stronger forms of these drugs may increase the risk of dementia in older patients.
These medicines include everything from milder medicines such as Benadryl to more potent medicines, such as certain antipsychotics and Parkinson’s meds. They’re used to treat a wide range of other conditions, including depression, chronic obstructive pulmonary disease, overactive bladder, allergies, and gastrointestinal disorders.
Anticholinergic drugs help contract and relax muscles, and work by blocking acetylcholine, a chemical that transmits messages in the nervous system.
But the new British study found that people aged 55 and older who took strong anticholinergic medications daily for three years or more had a 50% increased risk of dementia.
“Our study adds further evidence of the potential risks associated with strong anticholinergic drugs, particularly antidepressants, bladder antimuscarinic drugs, anti-Parkinson drugs and epilepsy drugs,” said study author Carol Coupland. She works in the division of primary care at the University of Nottingham.
Anticholinergics are known to cause short-term side effects — including confusion and memory loss — but it’s unclear if long-term use increases the risk of dementia.
There was no increased risk of dementia among patients who took other types of anticholinergic drugs such as antihistamines and gastrointestinal drugs.
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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.
What Kinds Of Questions Should You Ask Your Doctor About Any Drug Being Prescribed
- What are the potential benefits of taking this drug?
- How long before improvement may be noticed?
- What action should be taken if a dose is missed?
- What are the known side-effects?
- If there are side-effects, should the dosage be reduced or should the drug be stopped?
- If the drug is stopped suddenly, what happens?
- What drugs might interact with the medication?
- How might this drug affect other medical conditions?
- Are there any changes that should be reported immediately?
- How often will a visit to the doctor who prescribed the drug be needed?
- Is the drug available at a subsidised rate?
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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.
Widely Used Class Of Drugs Linked To Dementia
“Common drugs taken by millions ‘increase risk of dementia by 50%’, experts warn,” The Sun reports. The drugs in question are known as anticholinergics. Anticholinergics are drugs that block the nerve chemical acetylcholine, which transmits signals to muscles and glands in the body such as ones releasing saliva or digestive juices.
They are used to treat a wide range of health problems, such as overactive bladder, epilepsy, motion sickness and Parkinson’s disease.
The Sun’s headline is prompted by a new study that compared people with and without dementia to see whether there was any difference in their previous use of anticholinergic drugs.
The researchers found that use of anticholinergics was linked with between a 6% and 49% increased risk of dementia, depending on the dose and duration of use.
With this type of study, it is always difficult to prove direct cause and effect. The causes of Alzheimer’s in particular are poorly understood and various other health and lifestyle factors could be involved in the mix. Nevertheless, this is an important finding that needs looking into further.
But it’s important that people do not stop taking any prescribed medicine without speaking to their doctor. The risk from stopping the medicine may be far higher than any dementia risk.
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Q What Medications Are Associated With Dementia Risk
A. The 2019 AmericanGeriatric Society Updated Beers Criteria provides recommendations onmedications that are potentially inappropriate in older adults. This criteriasuggests that medications like anticholinergics and hypnotics should be avoidedin patients with dementia if possible. Evidence suggests that these types ofmedications could contribute to or worsen dementia.
This broad category of medications includes drugs we use to treat urinary incontinence, depression, muscle spasms, and even allergies. Anticholinergic medications are also in products that you can buy over-the-counter.
Most over-the-counter medications for sleep or nighttime symptoms have diphenhydramine , or a similar type of medication, which can affect cognition. When older adults with cognitive concerns are taking these medications, we talk to them about alternative treatments that do not affect cognition. Other examples of anticholinergic drugs include cyclobenzaprine and oxybutynin .
These medications include benzodiazepines and medications like zolpidem . Doctors often prescribe them to help with sleep or anxiety. Fortunately, there are alternative agents that can be used. So when patients have dementia or problems with memory, we often try to substitute a different medication with fewer cognitive effects.
Otherexamples of these drugs include diazepam ,lorazepam , and alprazolam
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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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.
What Prescription Drugs Are Linked To Alzheimers
. Hereof, can certain medications cause Alzheimers?
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 Parkinsons 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 Alzheimers 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.
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