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A large family of commonly used drugs can harm the brain and cause long-term cognitive impairment in older people

  [ 172 votes ]   [ Discuss This Article ] • July 13, 2010

“As a geriatrician I tell my patients...not to take these drugs, and I encourage all older adults to talk with their physicians about each and every one of the medications they take." - Dr. Malaz Boustani, MD

Drugs commonly taken for a variety of common medical conditions - from insomnia, allergies, or bladder leakage to depression, anxiety, irritable bowel, COPD, Parkinson’s, acid reflux and pain - negatively affect the brain, causing long term cognitive impairment, according to a study published July 13 in Neurology.(1)

A large family of prescription and branded OTC drugs.

These drugs, called anticholinergics, block acetylcholine, a nervous system neurotransmitter, and are widely-used.

• They are sold over the counter under various brand names such as Benadryl®, Dramamine®, Excedrin PM®, Nytol®, Sominex®, Tylenol PM®, and Unisom®.

• Other anticholinergic drugs, such as Paxil®, Detrol®, Demerol® and Elavil® are available only by prescription.

(To review a list of medications with anticholinergic effects – the Anticholinergic Cognitive Burden Scaleclick here. A list of recommended alternative meds is also offered.)

Older adults most commonly use drugs with anticholinergic effects as sleep aids and to relieve bladder leakage problems.

The authors of the study - researchers at Indiana University School of Medicine, the Regenstrief Institute, and Wishard Health Services, all based in Indianapolis - conducted a six-year observational study, evaluating 1,652 area African-Americans over the age of 70 who had normal cognitive function when the study began.

In addition to monitoring cognition, the investigators tracked all over-the-counter and prescription medications taken by study participants.

Taking one – significant risk. Taking two – doubles the risk.

"We found that taking one anticholinergic significantly increased an individual's risk of developing mild cognitive impairment and taking two of these drugs doubled this risk. This is very significant in a population - African-Americans - already known to be at high risk for developing cognitive impairment," said Noll Campbell, PharmD, first author of the study. He is a clinical pharmacist with Wishard Health Services.

The researchers believe the results are generalizable to all races. Previous shorter studies, including one involving older Catholic nuns and clergy and one involving patients of a VA primary care clinic, reached similar conclusions.(2,3)

"Simply put, we have confirmed that anticholinergics, something as seemingly benign as a medication for inability to get a good night's sleep or for motion sickness, can cause or worsen cognitive impairment, specifically long-term mild cognitive impairment which involves gradual memory loss,” says co-author Malaz Boustani, MD, a Regenstrief Institute investigator.

“As a geriatrician I tell my Wishard Healthy Aging Brain Center patients not to take these drugs and I encourage all older adults to talk with their physicians about each and every one of the medications they take," Dr. Boustani says.

"The fact that we found that taking anticholinergics is linked with mild cognitive impairment, involving memory loss without functional disability, but not with Alzheimer’s Disease, gives me hope,” Dr. Boustani added.

“Our research efforts will now focus on whether anticholinergic-induced cognitive impairment may be reversible… This study offers a new window to change the burden of dementia for the individual, the caregiver and the healthcare system."

According to Dr. Campbell, "This finding of a link between anticholinergics and long term mild cognitive impairment complements our previous work, which confirmed a link between anticholinergics and delirium, which is a sudden onset cognitive impairment."

The study was funded by the National Institute on Aging.

1. “Use of anticholinergics and the risk of cognitive impairment in an African American population,” Campbell NL, et al. Neurology, Jul 13, 2010

2. “Anticholinergic Drugs May Increase Cognitive Decline,” by Susan Jeffrey, April 18, 2008. Based on a presentation at the American Academy of Neurology 60th Annual Meeting.

3. “Cumulative anticholinergic exposure is associated with poor memory and executive function in older men.”  Han L, et al. Journal of the American Geriatric Society, Dec. 2008

Source: Adapted from Indiana University School of Medicine news release, July 13, 2010

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