Commonly used medications may produce cognitive impairment in older adults
June 1, 2009
This is Malaz Boustani, M.D. of the Regenstrief Institute, the Indiana University School of Medicine and the Indiana University Center for Aging Research. Credit: Regenstrief Institute
Many drugs commonly prescribed to older adults for a variety of common medical conditions including allergies, hypertension, asthma, and cardiovascular disease appear to negatively affect the aging brain causing immediate but possibly reversible cognitive impairment, including delirium, in older adults according to a clinical review now available online in the Journal of Clinical Interventions in Aging, a peer reviewed, open access publication.
Drugs, such as diphenhydramine, which have an anticholinergic effect, are important medical therapies available by prescription and also are sold over the counter under various brand names such as Benadryl®, Dramamine®, Excederin PM®, Nytol®, Sominex®, Tylenol PM®, and Unisom®. Older adults most commonly use drugs with anticholinergic effects as sleep aids.
While it is known that these medications do have an effect on the brain and in the case of sleeping pills, are prescribed to act on the brain, the study authors suggest the amount of cognitive impairment caused by the drugs in older adults is not well recognized.
"The public, physicians, and even the Food and Drug Administration, need to be made aware of the role of these common medications, and others with anticholinergic effects, in causing cognitive impairment. Patients should write down and tell their doctor which over-the-counter drugs they are taking. Doctors, who often think of these medications simply as antihistamines, antidepressants, antihypertensives, sleep aids or even itching remedies, need to recognize their systemic anticholinergic properties and the fact that they appear to impact brain health negatively. Doing so, and prescribing alternative medications, should improve both the health and quality of life of older adults," said senior study author Malaz Boustani, M.D., Indiana University School of Medicine associate professor of medicine, Regenstrief Institute investigator, and research scientist with the IU Center for Aging Research.
Dr. Boustani and colleagues conducted a systematic evidence-based analysis of 27 peer reviewed studies of the relationship of anticholinergic effect and brain function as well as investigating anecdotal information. They found a strong link between anticholinergic effect and cognitive impairment in older adults.
"One of the goals of our work is to encourage the Food and Drug Administration to expand its safety evaluation process from looking only at the heart, kidney and liver effects of these drugs to include effects of a drug on the most precious organ in human beings, our brain," Dr. Boustani said.
"Many medications used for several common disease states have anticholinergic effects that are often unrecognized by prescribers" said Wishard Health Services pharmacist, Noll Campbell, Pharm.D., first author of the study, noting that these drugs are among the most frequently purchased over the counter products. "In fact, 50 percent of the older adult population use a medication with some degree of anticholinergic effect each day."
"Our main message is that older adults and their physicians should have conversations about the benefits and harms of these drugs in relation to brain health. As the number of older adults suffering from both cognitive impairment and multiple chronic conditions increases, it is very important to recognize the negative impact of certain medications on the aging brain," said Dr. Boustani.
The brain pharmacoepidemiology group of the IU Center for Aging Research currently is conducting a study of 4,000 older adults to determine if the long term use of medications with anticholinergic effects is linked to the irreversible development of cognitive impairment such as Alzheimer disease.
4 hours ago
Unfortunately, treating symptoms rather than the cause all too common in common practices today. Particularly for the aging, pain, insomnia caused by pain, stress, etc. sticky-wickets as avenues are limited in successfully discovering/addressing the core problems without expensive diagnostic testing. Anti-depressant medications which are commonly prescribed for aging patients, combined with anticholinergics, could also prove interesting in discovering hormonally/chemically induced decreases in cognitive abilities.
Thanks to endless advertising, remedies sold on testimonials; patients young and old are encouraged to self-diagnose and treat without foundations of knowledge.
Preparations formerly Rx only are commonly available. That 30 sec ad seeks to replace the knowledge/education/experience of physician/nurses who now are so time constrained, it isn't possible to provide careful questioning, inspection and examination of the patient to determine hidden underlying issues which requires patience as well as time, in particular for older patients.
With continued lack of access, time constraints of primary care providers, metering of care to favor patient 'responsibility' in their health care choices we can expect more untoward and unexpected complications.
Faddish health trends, repackaging and labeling of medications, mythical "supplemental" and alternative choices use not overseen by the FDA complicates the picture for health care providers.
This research is welcome, the picture is vastly complex to unravel the causes of shortened attention spans and early decreased cognitive ability of aging from factors outside of the aging process itself.
At least it won't damage your health when it comes to treating minor ailments. Bear in mind that these drugs mentioned above are "official" ie approved by medical authorities etc. We are not talking some Net drug scam. Better yet, stay away from any drugs unless you *seriously* need them. The stories of people I have known who have had side effects from prescription medicines are almost unbelievable. If they weren't too ill to start with they sure were by the time they'd popped the docs pills. And the absolute worst of all in my experience are steroids.