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Common medicines tied to cognitive impairment and an increased risk of dementia (2016-07-08)

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;

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