Common Drugs Used by Older Adults Cause Cognitive Decline, Worse

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Benadryl®, Nytol®, Paxil®, Demerol®--what do these drugs have in common? According to a new study, these and other over-the-counter and prescription medications have anticholinergic activity that can cause cognitive decline and death in older adults.

Sleeping pills, incontinence drugs affect cognition

Anticholinergics are drugs that inhibit impulses produced by the parasympathetic nerves by selectively blocking a neurotransmitter called acetylcholine from attaching itself to its receptor in nerve cells. Anticholinergic drugs and drugs with anticholinergic properties are used to conditions such as hypertension, gastrointestinal cramps, asthma, motion sickness, muscular spasms, urinary incontinence, cardiac arrhythmias, Parkinson’s disease, insomnia, depression, and many others.

The new two-year study evaluated the effect of medications with anticholinergic activity on 13,000 men and women aged 65 and older who were part of a large multicenter, longitudinal study based in the United Kingdom that is looking at cognitive function and health in older adults.

According to Chris Fox, MD, of the University of East Anglia, a psychiatrist, and one of the study’s lead authors, “We looked at drugs with either moderate and severe anticholinergic activity….[and] we found that taking anticholinergic medications was linked to cognitive impairment and for the first time to death.”

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The investigators noted that medications with anticholinergic activity were more likely to be used by older adults, people with lower income, and individuals with a greater number of health conditions. Women were also more likely to report taking anticholinergic medications than were men, as were study participants who lived in institutions.

Co-author Malaz Boustani, MD, Indiana University School of Medicine associate professor of medicine, and research scientist with the IU Center for Aging Research, pointed out that “clinicians need to review the cumulative anticholinergic burden in people presenting with cognitive impairment to determine if the drugs are causing decline in mental status.”

An earlier study had noted a relationship between use of drugs with anticholinergic activity and cognitive impairment. In 2008, researchers at the 60th Annual Meeting of the American Academy of Neurology reported on 870 older adults in a religious order. When comparing 191 individuals who never took a drug with anticholinergic properties with 679 who used such drugs, the investigators found medications with anticholinergic activity were associated with a more rapid decline in cognitive function.

This latest study, however, is the first to identify a possible link between use of drugs with anticholinergic activity with both cognitive decline and death in older adults. These findings highlight the need for physicians to review medications taken by their older patients and determine if they are causing cognitive decline.

SOURCES:
American Academy of Neurology abstract
Indiana University news release
Monthly Prescription Reference

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