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If you’re worried about developing dementia, you’ve probably memorized a list of things you should do to minimize your risk—eating the right diet, exercising regularly, getting enough sleep, and keeping your mind and spirit engaged. In addition, some medications you may be taking to help you achieve these goals may increase your risk of dementia. In two separate large population studies, both benzodiazepines (a category that includes anti-anxiety drugs and sleeping pills) and anticholinergics (a group that includes drugs for allergies and colds, depression, high blood pressure, and urinary incontinence) were associated with an increased risk of dementia in people who used them for more than a few months. In both cases, the effect increased with the dose of the drug and the duration of use.
Medication To Calm Dementia Patients
These findings did not come as a complete surprise to the doctors who treated the elderly. The American Geriatric Society’s Beer List has long recognized benzodiazepines, antihistamines, and tricyclic antidepressants as potentially inappropriate for the elderly given their side effects. These drugs are on the list because they share troubling side effects — confusion, foggy thinking and memory loss — that can lead to falls, fractures and car accidents.
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It should be noted that none of these studies were randomized controlled trials, so none of them found that any type of drug causes dementia.
Anticholinergic test. The researchers tracked nearly 3,500 men and women age 65 or older who participated in the Adult Changes in Thought (ACT) study, a long-term study conducted by the University of Washington and Group, Seattle Health System. They used the group’s pharmacy records to identify all drugs, both prescription and over-the-counter, that each participant took in the 10 years before the start of the study. The participants were followed for an average of seven years. During this time, 800 of them developed dementia. When researchers examined the use of drugs, they found that people who used anticholinergic drugs were more likely to develop dementia than those who did not. In addition, the risk of dementia increased with cumulative doses. Taking an anticholinergic drug for the equivalent of three years or more was associated with a 54% higher risk of dementia than taking the same dose for three months or less.
The Washington University study is the first to include over-the-counter drugs. It is also the first to eliminate the possibility of taking medications to alleviate the early symptoms of undiagnosed dementia. People taking bladder anticholinergics had an increased risk as high as those taking tricyclic antidepressants, which are also anticholinergics.
Benzodiazepine study. A team of researchers in France and Canada has linked the use of benzodiazepines to an increased risk of being diagnosed with Alzheimer’s disease. In the study, the greater the cumulative dose of benzodiazepines, the greater the risk.
Patients And Families Overview
The researchers relied on a database maintained by Quebec’s insurance program. Based on this, they identified nearly 2,000 men and women over the age of 66 who were diagnosed with Alzheimer’s disease. They randomly selected more than 7,000 other people without Alzheimer’s disease, matched by age and gender to those with the disease. Once the groups were established, researchers looked at drug prescriptions in the five to six years before Alzheimer’s disease was diagnosed.
People who took a benzodiazepine for three consecutive months or less had about the same risk of dementia as people who had never taken it. But those who took benzodiazepines for three to six months had a 32% greater risk of developing Alzheimer’s disease, and those who took the benzodiazepine for more than six months had an 84% greater risk than those who did not take the benzodiazepine.
The type of drug used also mattered. People who took long-acting benzodiazepines such as diazepam (Valium) or flurazepam (Dalmane) were at greater risk than people who took short-acting benzodiazepines such as triazolam (Halcion), lorazepam (Ativan), alprazolam (Xanax), or temazepam (Restore).
Our ability to process drugs changes with age. The kidneys and liver clear drugs more slowly, so blood levels of the drug remain higher for a longer period of time. People also gain weight and lose muscle mass over time. Both of these changes affect how drugs are distributed and broken down in the body’s tissues. And because these drugs are stored in fat tissue, they can still have effects several days after you stop taking them, especially in people with higher body fat. In addition, older adults tend to take more prescription and over-the-counter medications, each of which can suppress or enhance the effects of others.
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Both anticholinergics and benzodiazepines affect the activity of neurotransmitters – chemical messengers that act in the central nervous system – but the drugs work in slightly different ways.
Anticholinergic drugs block the effect of acetylcholine. In the brain, acetylcholine is involved in learning and memory. In the rest of the body, it stimulates the autonomic nerves—those that regulate the contraction of blood vessels, airways, and our cardiovascular and digestive systems. Some of the most potent anticholinergics include certain antihistamines, tricyclic antidepressants, medications to control overactive bladder, and sleeping pills.
Benzodiazepines increase the effectiveness of another neurotransmitter. They make gamma-aminobutyric acid (GABA) – which slows down the activity of nerve cells in the brain – stronger. For this reason, they are used to relieve anxiety and help people sleep.
It is always a good idea to discuss the potential benefits and harms of these medications with your doctor. If a drug seems problematic, you can both investigate alternatives, take into account the reason it was prescribed and see if there is another type of drug that can be used as a substitute.
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Don’t stop taking drugs on your own. It is not safe to give up most benzodiazepines and anticholinergics cold turkey. Work with your doctor to develop a tapering plan.
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Get helpful tips and tricks on everything from fighting inflammation to finding the best diet for weight loss…from exercise to building a stronger core to cataract treatment tips. PLUS, the latest news on medical advances and breakthroughs from experts at Harvard Medical School. Diane Schoenfeld comes to Chaparral House in Berkeley, California every Friday to spend time with her aunt Lillie Manger.
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Manger is 97 years old. Today she has straight, gray hair in a neat bun. She is tied with a green scarf, a stylish reminder of the dancer she once was.
They go to the dining room together to look at family photos. The boss needs to be reminded who is in them. Including herself. “That’s me?” she asks. “You are,” her niece confirms.
Many people have dementia. Schoenfeld is her “surrogate decision maker,” meaning he is legally the person making decisions about Mangera’s health care. Schoenfeld says Chaparral House is the second nursing home Manger has lived at. It was 45 minutes until the first one, and Schoenfeld couldn’t visit very often.
In this first home, caregivers recommended antipsychotic sedatives for certain Manger behaviors, such as crying and tantrums. Schoenfeld was not keen on the idea, but agreed, believing that her aunt could receive better care if the staff were not displeased with her behavior.
Dangers Of Antipsychotic Medications For Dementia Patients
Two years later, Schoenfeld moved his aunt to Chaparral House to be closer to her. At the time, Manger seemed to be in a fog. Eventually, Schoenfeld got the idea to wean his aunt off the drugs. As soon as they did, he says, the situation turned.
“I could see her personality again, I was very happy,” Schoenfeld said. “My sister came to visit and (Aunt Lill) used my sister’s name and recognized her clearly, something we haven’t seen in the years she was medicating. AND
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