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

Is this Normal Aging?

It can be difficult to separate the normal aging process from the progressive and steep declines typical of Dementia. Examples of genuinely age-related changes are thinning and graying hair, sagging skin, and alterations in vision, hearing, and taste. Other changes, such as heart disease and certain types of memory loss, are not a normal part of aging.

 

The normal aging process may affect memory by changing the way the brain stores and retrieves information. While healthy aging does not affect long-term memory, it may affect short-term memory by making it difficult to remember such things as the name of a new acquaintance or misplacing keys or eyeglasses. Occasional word-recall difficulties, rather than frequent ones, are another indicator of healthy aging.

 

How people evaluate isolated events is one way to distinguish normal memory lapses from those caused by dementia. At one time or another, everybody loses a car in a parking lot. With normal forgetfulness, we chalk up those moments of frustration to the number of look-alike cars or having our thoughts elsewhere. A person who has Dementia is sure someone has moved the car.

Name recall and word-finding are other ways to distinguish memory losses caused by the normal aging process from those resulting from Dementia. A person with occasional age-related memory difficulties might ask for a reminder or wait a moment for the right word to show-up. A person with Dementia frequently has trouble finding and using the right word. To compensate, he or she may use either an awkward substitution or a description in place of the word. For example--a furry animal that purrs to replace the word “cat.” Further, there may be a noticeable decline in his or her capability to maintain a conversation.

 

Clinicians use the term “impoverished “to describe the Dementia-related changes in language complexity and vocabulary.

The ability to use household items is another indicator of Dementia. Most people find it annoying or frustrating when upgrading a home appliance to one that is heavy in technology or with new features. The source of annoyance often stems from changes in vision or the reduction in dexterity that arthritis may cause. However, people who have Dementia no longer know how to use their familiar dishwasher or drier.

When considering whether a set of symptoms indicates dementia or normal aging, one must evaluate whether the symptoms are a nuisance, problematic, or debilitating. This is best accomplished with the help of appropriate medical professionals and input from caregivers and loved ones.

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

Alzheimer's Disease-Type Dementia

Alzheimer's Disease (AD) is thought to be the most common kind of Dementia. Researchers estimate that as many as 5.4 million people living in the United States have this type of Dementia.¹  Whereas, when you combine all forms of Dementia together, it is estimated to affect 9 million or more people in the U.S.

According to the Centers for Disease Control and Prevention, Alzheimer's Disease is the fifth most frequent cause of death for adults aged 65 years and older.² Further, in high-economic countries³  like the U.S. and Canada, when considering the larger domain - that includes of all types of Dementia - Dementia is thought to rank even higher as the third leading cause of death, behind heart disease as number 1 and stroke as number 2.

While it is hard to say what actually causes Alzheimer's Disease, we do know the deposition and accumulation of fibrous proteins accompanies irreversible brain damage. It is thought that these insoluble proteins form β-amyloid plaques that disrupt brain architecture alter how brain cells use energy, and promote cell death. The second hallmark of AD, also seen by Dr. Alois Alzheimer over 100 years ago under a microscope, are the neurofibrillary tangles of dead and dying neurons seemingly connected to Tau, another type of protein. That's why medical professionals will often speak of the "plaques and tangles" of AD.

The result is a slow and progressive decline in memory, thinking, and reasoning skills. Eventually people lose the ability to swallow and breathe in a coordinated fashion. Even in the absence of other catastrophic diseases such as kidney failure and cancer, Alzheimer's Disease is a terminal illness.

Alzheimer's Disease comprises a spectrum rather than a defined set of signs and symptoms. Slow progression, rather than sudden change, is often the key to differentiating Alzheimer's behaviors from those associated with other kinds of Dementia. Life expectancy after an Alzheimer's diagnosis can be anywhere from four to 20 years. People who have Dementia often die from other causes such as cancer, kidney failure, and cardiovascular disease.

The Alzheimer's Association lists the 10 warning signs of Alzheimer's Disease – the first of which is memory loss. After reading the list you might think, How are these behaviors different from what everybody does at one time or another? The difference is the frequency and the ability to make self-corrections.

Healthcare providers often use staging to describe the progression and severity of diseases such as cancer, kidney failure, and Dementia. The following staging criteria will help you understand your loved-one’s condition and plan for future caregiving needs.

Mild or Early-stage Alzheimer's Disease

In this first stage, people experience memory loss, difficulty remembering newly learned information, and have trouble completing complex tasks such as planning a family event. Personality changes such as uncharacteristic anger and increasing difficulty in finding the right words, getting lost, or misplacing items are other common signs. With help, your parent, spouse, or sibling may still be capable of independent living.

Moderate or Mid-stage Alzheimer's Disease

During this phase people may confuse family members with close friends, forget personal history details such as where they went to school or where they were born, and need help with dressing and personal hygiene. Some people may become restless, suspicious of others, and confrontational. At this stage, your relative will need close supervision and assistance during the day and perhaps a caregiver during the night.

Severe or Late-stage Alzheimer's Disease

In the course of this last stage, people who have Dementia lose the ability to speak coherently, need help with eating, dressing, using the bathroom, and walking. Eventually, Late-stage Alzheimer's patients lose the ability to swallow and control their bladder and bowels. During this final stage, your loved-one will need 24-hour care, either at home or in a Dementia care facility.

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.

References

1. 2017 Facts and Figures: Alzheimer’s Disease Facts and Figures, Download source here: 2017 Alzheimer’s Disease Facts and Figures. (accessed September 18, 2017). 

2. ibid

3. 2017 World Health Organization Factsheet Download source here: 2017 World Health Organization Factsheet.