Take these drugs to forget: New insights into common drugs that lead to memory loss
Key Takeaways
Industry Buzz
"So I’m doomed. Either insufferable heartburn, anxiety and chronic allergies. Or get dementia." — Patient comment, @harried.cherie
"Anything that sedates your brain for a long period of time, including anesthesia, can cause dementia." — Dr. Zain Hasan, @doctarz
For patients experiencing allergies, sleep troubles, anxiety, or overactive bladders, certain medications that treat these common ailments may put them at increased risk of dementia.
The worst offenders include anti-anxiety medications and sleeping pills (such as benzodiazepines), along with anticholinergics used to treat an array of things like allergies, colds, depression, high blood pressure, and incontinence.
Let’s dive into the research showing how these seemingly harmless medications can put your patients at higher risk of cognitive decline.
@doctarz Five common medications that can cause #dementia #doctor #nurse ♬ Boundless Worship - Josué Novais Piano Worship
OTC and prescription sleep medications
A recent study published in the Journal of Alzheimer’s Disease investigated the links between a variety of sleep medications and dementia.[] In this 15-year study, the researchers particularly looked for any race-specific association between the frequency of sleep medication use and risk of incident dementia. The study included 3,068 community-dwelling older adults aged 74.1±2.9 years.
The following categories of medications were included in the study:
OTC:
antihistamines (diphenhydramine or doxylamine)
melatonin
valerian
Prescription drugs:
trazodone
antidepressants (doxepin, amitriptyline, imipramine, and mirtazapine)
antipsychotic (hydroxyzine)
benzodiazepines (flurazepam, estazolam, triazolam, temazepam, lormetazepam, loprazolam, nitrazepam, quazepam, alprazolam, lorazepam, diazepam, clonazepam, and oxazepam)
zolpidem
Indeed, the study found some connections between sleep medications and dementia—but also race. As the authors noted, those who reported taking medications for sleep “often or almost always had a significantly increased risk of developing dementia 15 years later.”[]
However, these findings were only true for a specific race: “This association was only found among Whites and was independent of sleep duration and quality. Further study of type of sleep medications will help to understand potential mechanisms, especially for the observed race differences,” the authors wrote.
@drsermedmezher Taking These Meds Can Increase Dementia Risk by up to 43% #medicine. Acetylcholine is a neurotransmitter that plays a crucial role in various brain functions, contributing to cognition, memory, attention, and motor control. Its importance in the brain stems from its widespread distribution and diverse effects on neuronal signaling. Here's why acetylcholine is so essential in the brain: Learning and Memory: Acetylcholine is closely associated with cognitive processes such as learning and memory. It plays a key role in synaptic plasticity, the ability of synapses to strengthen or weaken over time in response to learning and experience. Acetylcholine release in specific brain regions, such as the hippocampus, facilitates memory formation and consolidation, allowing for the encoding and retrieval of new information. Attention and Alertness: Acetylcholine modulates arousal, attention, and wakefulness, helping to regulate the sleep-wake cycle and maintain alertness during waking hours. Dysfunction of the cholinergic system can lead to deficits in attention, concentration, and vigilance, as seen in conditions such as attention deficit hyperactivity disorder (ADHD) or narcolepsy. Motor Control: Acetylcholine is involved in motor control and coordination, particularly in the peripheral nervous system where it acts on neuromuscular junctions to stimulate muscle contraction. In the brain, acetylcholine released from motor neurons in the basal ganglia and motor cortex helps regulate voluntary movement and muscle tone, contributing to motor planning and execution. #meds #memory ♬ Suspense, horror, piano and music box - takaya
Timing matters
Harvard Health notes two additional studies that shed light on the risks of both anticholinergic drugs and benzodiazepines.[] Both groups of drugs “were associated with an increased risk of dementia in people who used them for longer than a few months.” The anticholinergic study included 3,500 men and women ages 65 or older.
The researchers noted a connection between these drugs and dementia, and that the risk increased with the cumulative dose. 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.”[]
Similar connections were found in the benzodiazepine study. Researchers from France and Canada linked benzodiazepine use to an increased risk of being diagnosed with Alzheimer’s disease. In the study, the greater people’s cumulative dose of benzodiazepines, the higher their risk.
Despite the connections observed, these two studies do not fully confirm that the drugs actually cause dementia: “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.”
Who should be concerned?
Due to these drugs’ connections with dementia risk, even younger adult patients should consider using them sparingly or avoiding them altogether.
The National Center for Health Research explains that “the risk of dementia will be increased even if the drug use started and stopped many years before the onset of the symptoms,” advising that patients aged 55 or older “may want to avoid regular or long-term use of anticholinergics and sleeping pills.”[]
Alternative solutions
Other options are available to support patients who want to avoid anticholinergics and benzodiazepines. To improve sleep without medications, the National Center for Health Research advises the following:[]
Establish bedtime routines
Exercise regularly
Finish eating 2 to 3 hours before bedtime
Avoid caffeine, nicotine, and alcohol
Avoid naps
Try breathing exercises
For patients seeking allergy relief, medications such as steroid nasal sprays, cetirizine, fexofenadine, or loratadine may be prioritized over diphenhydramine, advises the American Geriatrics Society.[]
Additionally, to treat anxiety and sleep disorders, the Society recommends replacing benzodiazepines with SSRIs such as citalopram or sertraline.
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