A widely used group of prescription and over-the-counter medications could speed up older adults’ mental decline, a series of studies in the US, Canada, France and Germany shows.
These meds are called anticholinergics (ACs for short). In addition to prescriptions, many over-the-counter allergy, cough, and cold medicines have anticholinergic properties.
ACs are widely used for a very good reason: They work. They’re effective in treating all kinds of conditions – from allergies and motion sickness to overactive bladder to high blood pressure, from depression to Parkinson’s disease.
The most frequently prescribed ACs include antidepressants (amitriptyline, bupropion, citalopram, escitalopram, fluoxetine, mirtazapine, nortriptyline, paroxetine, sertraline, venlafaxine), antipsychotics (aripiprazole, clozapine, olanzapine, quetiapine, risperidone), insomnia drugs (trazodone, zopiclone), and pain relievers (amitriptyline, cyclobenzaprine, nortriptyline).
All of them work by blocking acetylcholine, a chemical that transmits messages among nerve cells. This is why ACs have short-term side effects including confusion and fuzzy memory. But healthy older adults, UPI reported, “had an increased risk of developing mild cognitive impairment” such as “memory and thinking problems that may progress to dementia.”
A University of California, San Diego study followed 688 older adults with no memory or thinking skills problems, testing their mental acuity each year for ten years. More than half of those taking ACs regularly – many taking them in multiple medications – were found to be more likely to develop mild cognitive impairment.
Three similar studies – in France, Germany, and the US –reached similar conclusions: “that patients who take higher doses of stronger AC drugs are at greater risk of dementia” and that “those who stop using anticholinergics are at lower risk of dementia than those who continue.”
While it’s true that correlation doesn't prove causation, “[t]he preponderance of evidence suggests it's better to avoid these medications in older adults,” according to Dr. Allison Reiss, associate professor at NYU Long Island School of Medicine and advisory board member of the Alzheimer’s Foundation of America.
Especially if you’re taking several prescription medicines, as most seniors are, it makes sense to ask your doctor(s) about them. Which ones contain ACs? Are there equally beneficial meds which don’t that I can switch to? Are there any I can do without? (Dr. Reiss advises against taking “medications that aren’t necessary.”) What’s the safest way to taper off an AC medication and switch to a non-AC drug?
This is one example of why, while so many caregivers zoom in on just one aspect of senior care, it’s so important to step back and take a look at the holistic, overall, picture. That’s why Senior Insights works with you to develop a coordinated care plan, integrating your needs as determined by our thorough three-part assessment; your different doctors and their approaches to your health needs; your schedule; and your hobbies, interests, activities and social life. To learn more about the difference holistic senior care can make, please contact us for a consultation.