Medications: Help, Hurt, or Both?

In the United States, more than seven million people have mild cognitive impairment (MCI) or have dementia. According to Xueya Cai and colleagues, nearly half of these individuals have two additional chronic diseases that require they take five or more medications.1

As a consequence of age-related decreases in kidney and liver function, older people tend to excrete medications at a slower rate and are therefore more likely to experience stronger, and not always reversible, drug-induced side effects. Another factor is the potential for complicated interactions with the other prescribed and over-the-counter medications that older people may take. Research indicates that as people age, they become more sensitive to drugs that act on the central nervous system.2 

One group of medications, the anticholinergics, have recently come under increased scrutiny. This class of drugs slows or prevents the transmission of nervous system information to and from the brain. Some commonly used over-the-counter (OTC) medications, such as antihistamines for cold and allergy symptoms are anticholinergics. Prescription anticholinergic medications relieve symptoms associated with depression, muscle spasms, motion sickness, as well as those used to modify the behaviors associated with mental illnesses such as schizophrenia and bipolar disorder.

It is important to understand that memory loss and confusion along with dizziness or drowsiness may be symptoms of medication side effects, rather than dementia.  Therefore, the clinician must receive from the patient or his or her family a list of ALL prescribed and over-the-counter medications, as well as any dietary supplements and herbals, he or she may take.

 Anticholinergics can also interfere with the effectiveness of medications used to slow memory loss or long-term use, putting people at higher risk for MCI and dementia later in life.1,3 One example are the drugs used to treat overactive bladder: the “gotta go gotta go” kind of urinary incontinence. Medications such as Detrol® and Cymbalta® slow transmission of nervous system information to and from the brain and thereby quiet the unrelenting sensation of “gotta go."

The medications used to slow the memory loss associated with dementia do just the opposite. Drugs such as Aricept® and Namenda® increase communication between nerve cells in the brain. Taking both types of medications at the same time can worsen dementia.

A Wake Forest University of Medicine study shows that nursing home patients receiving individual medications to modify dementia symptoms and improve continence lost the ability to perform basic living skills, such as dressing and feeding themselves, 50 percent faster than those receiving dementia medications alone.4 

One must evaluate the overall risks and benefits of taking a medication known to affect the risk for dementia later-in-life or, in the short-run, worsen the disease. Be sure to discuss with your doctor any concerns about taking a medication that may increase dementia risk. Do not stop taking prescribed or recommended over-the-counter medicines without first consulting with your doctor.

Notes: 

1. Cai Z, N Campbell et al, “Long-term Anticholinergic use and the Aging Brain”, http://www.ncbi.nlm.nih.gov/pubmed/23183138, (accessed April, 25, 2016)

2. Drug-Induced Cognitive Impairment: Delirium and Dementia, http://www.worstpills.org/includes/page.cfm?op_id=459 (accessed, April 25, 2016)

3. Higher dementia risk linked to use of common drugs, GroupHealth Research Institute, https://www.sciencedaily.com/releases/2015/01/150126124721.htm (accessed April 25, 2015). 

4. Dual Treatment to Treat AD Symptoms and Behaviors, https://www.sciencedaily.com/releases/2008/04/080430134230.htm (accessed, April 25, 2016)

For Further Reading

Medications to Avoid in the Elderly, http://www.virginiageriatrics.org/consult/medications/medsList.html (accessed April 24, 2016) 

Contributor: Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice. Please consult your doctor. www.DementiaSociety.org

Medical Records

Many of us, when unable to answer simple questions about the medications we take, promise ourselves to make a list before our next appointment. We know it’s important, but we never seem to get around to doing so. Besides, we are quite sure our prescription history is already a part of our medical history file.

However, your doctor may not know about the prescriptions you have received from other clinicians, or if you take dietary supplements such as vitamins or alternative medicine herbals such as echinacea. Conversely, an emergency room doctor or another clinician may not easy access to your medical records.

Keeping a current record of all the medications your loved-one takes is especially important when dementia is part of the equation. People who have dementia may see physicians that, in addition to his or her family doctor, include a geriatrician, a neurologist or a psychiatrist. It’s also quite likely the person who has dementia will require evaluation and treatment for conditions unrelated to his or her dementia diagnosis. In addition, with the progression of dementia, memory loss and other disabilities, makes it imperative that a family member or other caregiver have access to the medication list.

As a first step, make a complete list of the medications, supplements, and any herbals your loved-one may use. The list, in the form of a table, should include the following information: the name of the medication, the daily dosage, the prescription number, the pharmacy contact information, the prescribing clinician’s name and contact information, as well as the location of the medication in your loved-one’s place of residence. You might also want to jot down a few words about any side effects, you or other people may have noticed.

As a second step, and on a need-to-know basis, a hard copy of the compiled information should be available to other family members as well as to other caregivers responsible for your loved one’s care. Place another paper copy in a folder or a three-ring binder and leave it by the telephone. The folder, in addition to the medication list, should also contain other important names and numbers such as the contact information for your loved-one’s doctors, as well as for the local hospital, ambulance service and emergency room.

Create a file on your computer hard-drive that contains the all information you need to oversee your loved one’s care. Doing so will make it easy to update your loved-one’s medical records. 
Do keep in mind that only certain people should have access to your loved-one’s Medicare, health insurance and credit card information as well as other types of confidential information. Doing so will help to prevent financial abuse and identity theft.

And while you are at it – this is a good time to finally get around to tabulating your medications and other types of personally important information!

Janet Yagoda Shagam, PhD, is a freelance medical and science writer and the author of “An Unintended Journey: A Caregiver's Guide to Dementia.” Available through Amazon.

The opinions expressed by contributing authors are not necessarily the opinions of the Dementia Society, Inc. We do not endorse nor guarantee products, comments, suggestions, links, or other forms of content contained within blog posts- that have been provided to us with permission, or otherwise. Dementia Society does not provide medical advice, please consult your doctor. www.DementiaSociety.org