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Commonly used drugs (anticholinergic, AC, medication
for problems like colds, allergies, depression, high
blood pressure and heart disease have long been
linked to cognitive impairment and dementia. Now
researchers have some fresh evidence that may help
explain the connection.
Known as anticholinergics these drugs stop a
chemical called acetylcholine from working properly
in the nervous system. By doing so, they can relieve
unpleasant gastrointestinal, respiratory or urinary
symptoms, for example.
The list of such drugs is long. Among them: Benadryl
for allergies, the antidepressant Paxil and the
antipsychotic Zyprexa, Dimetapp for colds and the
sleep aid Unisom.
Dimetapp (a combination of brompheniramine, an
antihistamine, and phenylephrine, a decongestant);
Diphenhyldramine (an antihistamine for allergies);
Paroxetine (antidepressant, is one of the most
potent and selective of the selective serotonin
reuptake inhibitors, SSRI);
Zyprexa, Olanzapine (is used to treat the symptoms
of psychotic conditions such as schizophrenia and
bipolar disorder).
To assess the association between AC medication use
and cognition, glucose metabolism, and brain atrophy
in cognitively normal older adults from the
Alzheimer’s Disease Neuroimaging Initiative (ADNI)
and the Indiana Memory and Aging Study (IMAS),
researchers looked at brain scans and cognitive test
results from 451 older adults – including 60 who had
been taking anticholinergic drugs for at least a
month. The study participants were about 73 years
old on average.
None of them had been diagnosed with cognitive
problems like Alzheimer’s disease or dementia.
The use of AC medication was associated with
increased brain atrophy and dysfunction and clinical
decline.
The brain scans of people who used anticholinergic
drugs showed lower levels of glucose processing in
the brain – an indicator of brain activity – in a
region of the brain associated with memory that’s
also affected early in the course of Alzheimer’s
disease.
In addition, patients who used these medications had
reduced brain volume and thickness in some regions
linked to cognitive function, the researchers report
in JAMA Neurology.
People who used these drugs also scored lower on
tests of immediate memory recall and executive
function compared to people who weren’t using these
drugs, researchers found.
Thus, use of AC medication among older adults should
likely be discouraged if alternative therapies are
available.
For more information
Jama Neurology
Original Investigation | June 2016
Association Between Anticholinergic Medication Use
and Cognition, Brain Metabolism, and Brain Atrophy
in Cognitively Normal Older Adults
Shannon L. Risacher, PhD; Brenna C. McDonald, PsyD,
MBA; Eileen F. Tallman, BS; John D. West, MS; Martin
R. Farlow, MD; Fredrick W. Unverzagt, PhD; Sujuan
Gao, PhD; Malaz Boustani, MD, MPH; Paul K. Crane,
MD, MPH9; Ronald C. Petersen, MD, PhD; Clifford R.
Jack Jr, MD; William J. Jagust, MD; Paul S. Aisen,
MD; Michael W. Weiner, MD; Andrew J. Saykin, PsyD;
Link...
Jama Internal Medicine
Original Investigation | March 2015
Cumulative Use of Strong Anticholinergics and
Incident DementiaA Prospective Cohort Study
Shelly L. Gray, PharmD, MS; Melissa L. Anderson, MS;
Sascha Dublin, MD, PhD,; Joseph T. Hanlon, PharmD,
MS; Rebecca Hubbard, PhD; Rod Walker, MS; Onchee Yu,
MS; Paul K. Crane, MD, MPH; Eric B. Larson, MD, MPH
Link...
MDN |