“All sleeping pills, 1st generation antihistamines and tricyclic antidepressants should be avoided at all costs in seniors.” – American Geriatric Society
After age 65, up to 90% of people take at least one prescription medication - and 18% of them complain of memory problems and are found to have mild cognitive deficits. Now new research led by Cara Tannenbaum, MD, a geriatric pharmacologist at the University of Montreal, suggests a frequent link between the two.
Dr. Tannenbaum recently led an international research team to investigate which medications are most likely to affect brain functions that are:
• Amnestic (involve memory)
• Or non-amnestic (involve attention, concentration, cognitive performance).
After analyzing the results from 162 experiments on medications with the potential to bind to cholinergic, histamine, GABA-ergic or opioid receptors in the brain, the team concluded that:
“The episodic use of several [types of] medications can cause amnestic or non-amnestic deficits.”
This potential cause is often overlooked in persons who are otherwise in good health, Dr. Tannenbaum notes. (And may affect younger adults as well, though the research has focused on older people, who take more of these meds, often several of them, and typically for extended periods, even years.)
• The 68 trials on benzodiazepines (which are often used to treat anxiety and insomnia) that were analyzed showed that these drugs consistently lead to impairments in memory and concentration, with a clear dose-response relationship. Higher dose, more effect.
• The 12 tests on antihistamines and the 15 tests on tricyclic antidepressants showed deficits in attention and information processing.
Overall, the study report, published in the journal Drugs & Aging, concludes, “Non-amnestic mild cognitive deficits are consistently induced by first-generation antihistamines and tricyclic antidepressants, while benzodiazepines provoke combined amnestic and non-amnestic impairments.” [A list of first-generation antihistamines/brand names sold over the counter as allergy, cold, and sleep aids can be found here.]
These findings support the American Geriatrics Society’s admonition published in its 2012 Revised Beers Criteria that “All sleeping pills, 1st generation antihistamines and tricyclic antidepressants should be avoided at all costs in seniors.”
Discuss with Your Pharmacist, and Physician
“Patients need this information so that they are more comfortable talking to their doctors and pharmacists about safer pharmacological or non-pharmacological treatment options," Dr. Tannenbaum explains.
And "seniors can play an important role in reducing the risks associated with these medications,” she says. Risks that extend beyond memory problems to include traffic accidents and falls.
She also points out that each case must be addressed on an individual basis: "Despite the known risks, it may be better for some patients to continue their medication instead of having to live with intolerable symptoms. Each individual has a right to make an informed choice based on preference and a thorough understanding of the effects the medications may have on their memory and function."
To physicians, the advice is to discuss risk-benefit considerations with patients “in order to enable an informed choice about drug discontinuation or substitution to potentially reverse cognitive adverse effects.”
Study Detail
This research was conducted in collaboration with researchers at the University of Sydney, the University of Calgary and the University of Iowa College of Public Health.
MEDLINE and EMBASE were searched for randomized, double-blind, placebo-controlled trials of adults without underlying central nervous system disorders who underwent detailed neuropsychological testing prior to and after oral administration of drugs affecting cholinergic, histaminergic, GABAergic or opioid receptor pathways. Seventy-eight studies were identified, reporting 162 trials testing medication from the four targeted drug classes. Two investigators independently appraised study quality and extracted relevant data on the occurrence of amnestic, non-amnestic or combined cognitive deficits induced by each drug class. Only trials using validated neuropsychological tests were included. Quality of the evidence for each drug class was assessed based on consistency of results across trials and the presence of a dose-response gradient.
Source: Based on University of Montreal news release, Nov 6, 2012
___
Note: This information has not been evaluated by the FDA. It is general information, is not intended to diagnose, treat or cure any illness, condition or disease, and must not take the place of the personal attention of a professional pharmacist or healthcare professional. It is very important that you make no change in your healthcare plan or health support regimen without researching and discussing it with your professional healthcare team.
