BRAIN AND NERVE CARE

Some Medications Increase Your Chances of Dementia

By Temma Ehrenfeld @temmaehrenfeld
 | 
September 13, 2016

You can find out quickly whether your prescriptions are among them.

When you go to the doctor, it’s a good idea to pile all your usual meds, including over-the counter remedies, into a bag and bring them along. You may learn that you can substitute a different medication or treatment with less risk. 

For example, several studies have found strong links between Alzheimer’s disease and other kinds of dementia and regular long-term use of anticholinergic meds. That group includes well-known, OTC products such Unisom SleepGells and Benadryl, which both contain diphenhydramine. Unisom SleepTabs also contain doxylamine, another antihistamine, which is anticholinergic. 

 

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Occasional use of an OTC drug isn’t grounds for panic, but any medication that is part of your daily routine for months or years should be evaluated carefully, especially as you age.   

Anticholinergic drugs block the action of acetylcholine, a chemical in the brain that sends messages in the nervous system. It aids learning and memory and stimulates muscle contractions. Our bodies make less of acetylcholine as we age, so older people are more likely to suffer when its action is blocked. Also, drugs can be more powerful in older people because our kidneys and liver clear drugs more slowly as we age, and we tend to be fatter. 

In a 2015 report published in JAMA Internal Medicine, a team examined pharmacy records for nearly 3,500 volunteers ages 65 and older. The researchers learned which medications, both prescription and OTC, the participants had used over the previous decade. The researchers also tracked their health for an average of seven years. It turned out that people who took an anticholinergic drug for three years or more had a 54 percent higher chance of developing dementia than people who took the same dose for three months or less. This was the first study to include OTC drugs.

 

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The most common anticholinergic drugs used in this group were the tricyclic antidepressants (including Elavil and Pamelor), older antihistamines like doxylamine, and drugs for bladder control. 

In June this year, more research confirmed the problem. This time the scientists looked at scores on standard tests and images of the brains of older adults without a diagnosis of Alzheimer’s. Compared to people who weren’t taking an anticholinergic drug, those who did so regularly had brain cavities — a measure of the brain atrophying — up to 32 percent larger. They also did worse on tests of short-term memory, verbal reasoning, planning, and problem-solving.

You can check up yourself on the medications you take. In 2008, Indiana University School of Medicine geriatrician Malaz Boustani developed the anticholinergic cognitive burden scale. Those with an “ACB” score of 3 pose the greatest risk. 

When we take a medication, we weigh any risks or side effects against the benefits. Never stop a drug abruptly without speaking to your doctor. Ask yourself — and then talk to your doctor — how well the drug is working and if you still need it. There may be other options. Instead of Paxil, which has an ACB score of 3, you might try a different antidepressant. If you regularly take OTC antihistamines, including Chlor-Trimeton, Benadryl, or Dimetapp, ask your pharmacist: Claritin (loratadine) and Zyrtec (cetirizine) aren’t anticholinergic. 

Bladder-control drugs block acetylcholine because it sends signals to your brain to contract your bladder even when it’s not full. You could reconsider the non-drug alternatives, such as Kegel exercises and cutting out alcohol, caffeine, and artificial sweeteners. 

Drugs with an “ACB” score of 3 include:

• Amitriptyline (Elavil)

• Amoxapine (Asendin)

• Atropine (Sal-Tropine)

• Benztropine (Cogentin)

• Brompheniramine (Dimetapp)

• Carbinoxamine Histex (Carbihist)

• Chlorpheniramine (Chlor-Trimeton)

• Chlorpromazine (Thorazine)

• Clemastine (Tavist)

• Clomipramine (Anafranil)

• Clozapine (Clozaril)

• Darifenacin (Enablex)

• Desipramine (Norpramin)

• Dicyclomine (Bentyl)

• Dimenhydrinate (Dramamine)

• Diphenhydramine (Benadryl)

• Doxepin (Sinequan)

• Doxylamine (Unisom)

• Fesoterodine (Toviaz)

• Flavoxate (Urispas)

• Hydroxyzine (Atarax, Vistaril)

• Hyoscyamine (Anaspaz, Levsin)

• Imipramine (Tofranil)

• Meclizine (Antivert)

• Methocarbamol (Robaxin)

• Nortriptyline (Pamelor)

• Olanzapine (Zyprexa)

• Orphenadrine (Norflex)

• Oxybutynin (Ditropan)

• Paroxetine (Paxil)

• Perphenazine (Trilafon)

• Promethazine (Phenergan)

• Propantheline (Pro-Banthine)

• Propiverine (Detrunorm)

• Quetiapine (Seroquel)

• Scopolamine (Transderm Scop)

• Solifenacin (Vesicare)

• Thioridazine (Mellaril)

• Tolterodine (Detrol)

• Trifluoperazine (Stelazine)

• Trihexyphenidyl (Artane)

• Trimipramine (Surmontil)

• Trospium (Sanctura)

 

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Updated:

September 13, 2016

Reviewed By:

Janet O’Dell, RN

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