A class of drugs that is taken by as many as one in four older adults has recently been shown to cause symptoms that mimic dementia. Now doctors are wondering whether long-term exposure to these medications can trigger symptoms of cognitive impairment that may prove irreversible.
Medications that Mimic Dementia are Widely Prescribed
We read about this startling news in this recent Kaiser Health News article, written by columnist Judith Graham. The type of medications under scrutiny are called “anticholinergic” drugs, which Graham describes as “a wide-ranging class of medications used to treat allergies, insomnia, leaky bladders, diarrhea, dizziness, motion sickness, asthma, Parkinson’s disease, chronic obstructive pulmonary disease and various psychiatric disorders.” Most of the meds containing these substances are available only by prescription, but some over the counter brand names also contain drug compounds with anticholinergic properties. The prescription drugs with the strongest effects include antidepressants such as Trofanil, antihistamines such as Vistaril and Atarax, antipsychotics such as Clozaril and FazaClo, antispasmodics such as Bentyl, and drugs for urinary incontinence such as Detrol.
“In addition to prescription medications,” Graham writes, “many common over-the-counter drugs have anticholinergic properties, including antihistamines such as Benadryl and Chlor-Trimeton and sleep aids such as Tylenol PM, Aleve PM and Nytol.”
Medications that Mimic Dementia Inhibit a Vital Brain Chemical
The common denominator with these medications, Kaiser explains, is that they act to suppress a chemical in the brain called acetylcholine. This “chemical messenger” plays a whole host of important functions in the nervous system. But it’s in the brain itself where too little acetylcholine can create conditions that masquerade as dementia. “In the brain, acetylcholine plays a key role in attention, concentration, and memory formation and consolidation,” Graham writes. Patients with insufficient acetylcholine experience a wide range of side effects including dizziness, confusion, drowsiness, disorientation, and agitation, among others – all common indicators of advancing cognitive impairment.
“Seniors are more susceptible to adverse effects from these [anticholinergic] medications for several reasons,” Graham explains: “Their brains process acetylcholine less efficiently. The medications are more likely to cross the blood-brain barrier. And their bodies take longer to break down these drugs.” Nevertheless, research has shown that doctors tend to attribute the symptoms of confusion, disorientation, and even delirium as age-related, not as a drug side effect. This often leads to misdiagnosis. In the Kaiser article, Judith Graham describes a woman in her 60’s who appeared to her doctor to have advanced dementia. But this physician suspected the true culprit was something else: the “cocktail” of medications she was taking for a wide range of ailments. Most of these drugs, some by prescription and some purchased over the counter, were strongly anticholinergic.
“He was right,” Graham writes. “Over six months, [the doctor] and a pharmacist took the patient off those medications and substituted alternative treatments. Miraculously, she appeared to recover completely.” On one test used to evaluate a patient’s cognitive state, this woman’s initial score – 11 out of a possible 30, signifying severe dementia – shot up to 28, considered to be in the normal range.
Medications that Mimic Dementia May Cause Permanent Impairment
But is there a possibility that the effects of anticholinergic drugs may become irreversible? Researchers have begun to be increasingly worried that this may be the case. Last June, JAMA Internal Medicine carried a report of research tracking 284,000 British adults age 55 and older between 2004 and 2016. The study showed that over half of these subjects had been prescribed at least one anticholinergic drugs, and many were taking more than one. According to researchers, subjects taking a daily dose of a strong anticholinergic drug for three years increased their dementia risk by 49 percent. “These findings don’t constitute proof that anticholinergic drugs cause dementia,” Kaiser cautions: “they show only an association. But based on this study and earlier research…it now appears older adults who take strong anticholinergic medications for one to three years are vulnerable to long-term side effects.”
More studies are underway to determine how best to reverse drug-caused dementia symptoms, if reversal is even possible. Meanwhile, if you or a loved one is taking anticholinergic drugs, a talk with your doctor is definitely in order. “Don’t try stopping cold turkey or on your own,” Judith Graham warns, because abrupt withdrawal often triggers severe side effects. Also, the article cautions, don’t assume that over the counter drugs are “automatically safe for your brain,” as one doctor put it. As noted above, many can inhibit the production of acetylcholine in the brain and impair your cognitive abilities. Be sure you tell your health care provider about all the pills you take.
Retirement Prescription: Good Medical Advice and Much More
If you or a loved one are facing a particular health challenge, or simply trying to plan for your health care needs as you age, we hope you’ll call us here at AgingOptions and allow us to refer you to a geriatric physician – a geriatrician – in your area. This is the health care professional you need to see, a doctor who understands the particular physical, emotional, and cognitive issues of aging patients. As for the rest of your retirement planning, we can help you there as well by showing you how all the facets of your retirement plan fit together like pieces of a puzzle. Along with your medical needs – helping you preserve your health – you need to take your housing desires into account, to make certain you’re living in the environment that’s right for you. In retirement, your finances will play a pivotal role, as will your legal affairs. Finally, unless your family is aware and supportive of your retirement plans, you could be heading for major family conflict in the future. An AgingOptions LifePlan is the one plan we know of that blends all these elements together: financial, legal, medical, housing and family.
If you’re ready to learn more, why not take a few hours and attend one of our free LifePlanning Seminars? There’s no obligation whatsoever – just bring your questions and prepare to have your eyes opened about a new approach to retirement security. For all the details, visit our Live Events page, or call us during the week and we’ll gladly assist you. We hope to see you very soon at an AgingOptions LifePlanning Seminar. Meanwhile, as we love to say, “Age on!”
(originally reported at www.khn.org)