Questions To Ask The Doctor If Drugs Are Prescribed
- What are the potential benefits of taking this drug?
- How long before improvement may be noticed?
- What action should be taken if a dose is missed?
- What are the known side effects?
- If there are side effects, should the drug be stopped?
- If the drug is stopped suddenly, what happens?
- What drugs might interact with the medication?
- How might this drug affect other medical conditions?
- Are there any changes that should be reported immediately?
- How often will a visit to the doctor who prescribed the drug be needed?
- Is the drug available at a subsidised rate?
Some Hypertension Drugs May Ward Off Memory Loss Study Finds
Researchers say the findings could change prescribing practices for people with high blood pressure.
Hypertension, which affects nearly half of U.S. adults, can put you at risk of heart disease and stroke. Research also shows that elevated blood pressure in middle age can increase a persons risk of dementia in older age. Evidence shows that some medications can actually stave off dementia for these people. But researchers didnt know which medications until now.
In a large-scale meta-analysis published June 2021 in the journal Hypertension, researchers found that people who took hypertension medications that travel out of blood vessels and enter the brain, known as crossing the blood-brain barrier, experienced less cognitive decline than those who used blood pressure drugs that stay only in the bloodstream.
We know that lowering blood pressure is beneficial for cognitive decline and risk for dementia, but there’s lots of different drugs. And the question was, do these drugs work through a variety of different mechanisms to benefit cognitive decline or is it just about lowering blood pressure? says the study’s corresponding author Daniel Nation, PhD, an associate professor of psychological science and a faculty member of the Institute for Memory Impairments and Neurological Disorders at the University of California in Irvine .
In all, the analysis included nearly 13,000 people older than 50 in 14 different studies conducted in six countries.
What Is Memory Why Does It Matter
According to an introductory psychology textbook, memory is the retention of information or experience over time as the result of three key processes: encoding, storage, and retrieval.
Encoding is getting information into memory. This could include encoding sights and sounds. Encoding is like taking a photo with a camera.
Storage is retaining information over time. Think of storage as similar to taking the photos off your camera, printing them, and adding them to a photo album.
Retrieval is taking information out of storage. Think of retrieval as flipping through the photo album. While flipping through the photos in the photo album, you have the opportunity to recall past details and experiences.
Memories play an important role in our bonds with others and our own personal sense of identity.
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Treating The Accompanying Symptoms Of Dementia
Dementia often causes a number of behavioural and psychological symptoms which can be very distressing.
These may include depression, anxiety, sleeplessness, hallucinations, ideas of persecution, misidentification of relatives or places, agitation and aggressive behaviour. These symptoms may respond to reassurance, a change in the environment or removal of the source of any distress such as pain. However, sometimes medication may be required for relief.
Major tranquillisers, also known as neuroleptics or anti-psychotics, are used to control agitation, aggression, delusions and hallucinations. Haloperidol is one commonly used drug. In modest doses this drug tends to cause symptoms similar to Parkinsons disease such as stiffness, shuffling gait and shakiness, and older people are very prone to these side effects. Some are unable to tolerate even low doses of Haloperidol.
Newer tranquillisers such as Risperidone have fewer Parkinsons like side effects and have been studied more intensively in people with dementia than Haloperidol has. Risperidone appears to be helpful for the treatment of aggression and psychosis, but may be associated with a slight increase in risk of stroke.
Olanzapine and Quetiapine are sometimes used, but have been less comprehensively studied in the treatment of dementia, and there is some evidence that Olanzapine may also be associated with increased risk of stroke.
Drugs for treating depression
Drugs for treating anxiety
Medicines To Treat Related Conditions
There are some conditions, such as heart problems, that can affect symptoms of dementia, particularly vascular dementia. It’s important that these are diagnosed and treated.
These conditions include:
These changes in behaviour can be very distressing, both for the person with dementia and for the person caring for them. However, there are coping strategies that can help.
If coping strategies do not work, antipsychotic medicines such as risperidone or haloperidol may be prescribed for those showing persistent aggression or extreme distress.
These are the only medicines licensed for people with moderate to severe Alzheimer’s disease and vascular dementia where there’s a risk of harm to themselves or others.
Risperidone should be used at the lowest dose and for the shortest time possible as it has serious side effects. Haloperidol can be used only if other treatments have not helped.
The decision to prescribe a medicine should be taken by a consultant psychiatrist.
Antidepressants may sometimes be given if depression is suspected as an underlying cause of anxiety.
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Medications That Block The Effects Of Acetylcholine
Among the best-recognized cognitively dangerous medications are those with anticholinergic properties. This means that the medications block the effect of acetylcholine, an important brain chemical and neurotransmitter that becomes less plentiful in the aging brain. These medications have an impact on brain cells by occupying its receptor molecules, and can help people gain relief from symptoms of insomnia, irritable bowel syndrome, or several other medical conditions. Also, many medications valued for their other effects have incidental anticholinergic properties. Among the clinically significant anticholinergic medications are medications such as tolteridine, often used to treat urinary incontinence. In addition, some antidepressants , antipsychotics, cardiac medications, antispasmodics, antivertigo medications, and antiparkinsonian medications have anticholinergic effects.
Unfortunately, the undesired consequences of anticholinergic medications can be serious. Dry mouth, dry eyes, constipation, or urinary retention may occur. The toxic effects of anticholinergic medications on the brain include confusion, memory disturbance, agitation, and even delirium.
What To Do If You Or Your Relative Is On These Medications
So what should you do if you discover that your older relative or you yourself are taking some of these medications?
If its an over-the-counter anticholinergic, you can just stop it. Allergies can be treated with non-sedating antihistamines like loratadine , or you can ask the doctor about a nasal steroid spray. PM painkillers can be replaced by the non-PM version, and remember that the safest OTC analgesic for older adults is acetaminophen .
If you are taking an over-the-counter sleep aid, it contains a sedating antihistamine and those are strongly anticholinergic. You can just stop an OTC sleep aid, but in the short term, insomnia often gets worse. So youll need to address the insomnia with non-drug techniques.
You should also discuss any insomnia or sleep problems with your doctors its important to rule out pain and serious medical problems as a cause of insomnia but be careful: many of them will prescribe a sleeping pill, because they havent trained in geriatrics and they under-estimate the risks of these drugs.
If one or more of the medications above has been prescribed, dont stop without first consulting with a health professional. Youll want to make an appointment soon, to review the reasons that the medication was prescribed, alternative options for treating the problem, and then work out a plan to reduce or eliminate the drug.
Now go check out those medication bottles, and let me know what you find!
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Common Types Of Medication That Are Anticholinergic
Here are seven common types of anticholinergic medication that older adults should avoid, or use with caution:
1. Sedating antihistamines. The prime example is diphenhydramine , which is available over-the-counter and has strong anticholinergic activity. Non-sedating antihistamines, such as loratadine are less anticholinergic and are safer for the brain.
2. PM versions of over-the-counter painkillers. Most OTC painkillers, such as acetaminophen and ibuprofen come in a PM or night-time formulation, which means a mild sedative usually an antihistamine has been mixed in. Ditto for night-time cold and cough medications such as Nyquil.
3. Medications for overactive bladder. These include bladder relaxants such as oxybutynin and tolterodine .
4. Medications for vertigo or motion sickness. Meclizine is often prescribed to treat benign positional vertigo. Its also used to treat motion sickness.
5. Medications for itching. These include the strong antihistamines hydroxyzine and diphendyramine , which are often prescribed for itching or hives.
6. Medications for nerve pain. An older class of antidepressant known as tricyclics isnt used for depression that much any longer, but these drugs are occasionally still used to treat pain from neuropathy. Commonly-used tricyclics include amitriptyline and nortriptyline.
7. Muscle relaxants. These include drugs such as cyclobenzaprine and they are often prescribed for back or neck pain.
Illegal Drugs That Cause Memory Problems
While people are attracted to drugs that make you forget things to escape underlying issues like depression, anxiety, and trauma, drug-induced memory loss may be more than what they bargained for. Research shows that many illegal drugs cause memory problems that are often irreversible. But this is no surprise, considering that most illicit drugs are potent enough to change the brains chemical makeup and cause addiction. Below is a list of illegal drugs that cause memory problems.
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What You Can Do About Medication Safety In Aging
So if youre an older adult, or if youre involved in the medical care of an aging relative, what can you do?
Dr. Steinmans advice, which he shared in the recent podcast episode, is to be proactive.
Although we do have a lot of information available regarding which medications are risky for older adults, and how to manage medications more safely, its still very common for older adults to experience inappropriate prescribing and also harms from their medications.
Most health providers are well-intentioned and caring. But theyre also often lacking the time, resources, and supportive systems they need to be more careful about medications.
So for now, if you want to improve your chances of using medication carefully, here are some suggestions:
- Review your medications, and try to find out if any are listed in the Beers Criteria. Pharmacists can be a good resource, if you want help spotting these medications.
- If you are taking a Beers list medication, HealthinAging.org offers a helpful resource here: What To Do And What To Ask If A Medication You Take Is Listed In The AGS Beers Criteria® For Potentially Inappropriate Medication Use In Older Adults.
I know it can seem a bit daunting to start asking a lot of questions about your medications, or your older parents medications.
Nonetheless, I want to encourage you to do it anyway! Yes, it can be a little extra work, but its your health and safety at stake.
You dont have to be one of them.
Other Rx Meds & Brain Fog Or Memory Loss:
There are so many medications that can cause confusion or memory loss that it would be hard to list them all. A systematic review in the journal Drugs & Aging describes medications that affect the GABA neurotransmitter system. They are called GABA agonists, gabapentinoids or GABAergics. You can learn much more about them at this link.
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Medications That May Cause Memory Loss
If one is increasingly forgetful or if one is having memory problems in his/her daily life then most likely he/she is suffering from a problem of memory loss. Memory loss can be either short-term or long-term. Short-term memory loss is forgetfulness of recent events while long-term memory loss is inability to retain memories that should be retained anywhere from a few days to the rest of life.
Most people consider memory loss as a sign of aging, but this is not always true. Aging is one of the causes, not the only cause of memory loss. Memory impairment can also occur due to side effect of some medications. One must be wise to choose a thing by comparing its effects versus side effects.
There are a number of medicines that can lead to memory loss some of them are listed as follows.
Beware: These 10 Medications Can Cause Memory Loss
Forgetfulness and mental confusion are often associated with aging, but the fact is, scientists have found that memory loss is not an inevitable part of aging. There are many factors that play a role in memory impairment, including alcohol and drug abuse, heavy smoking, head injuries, stroke, sleep deprivation, severe stress and illnesses such as Alzheimers disease and depression. Some of these are commonly known to affect memory, but there is one huge factor causing memory loss that is often overlooked. Many commonly prescribed drugs can interfere with memory. If youre currently taking medication and are having trouble remembering things, one of these may be the culprit.
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Is It Alzheimer’s Or Another Kind Of Dementia
Alzheimer’s disease is the most common cause of dementia and causes significant memory loss, in addition to multiple other symptoms. If you think your memory loss could be caused by Alzheimer’s, review the symptoms and make an appointment with your physician for an assessment. Although Alzheimer’s typically affects those over the age of 65, early-onset Alzheimer’s can occur in those as young as 40.
Memory loss can also be caused by other kinds of dementia, such as vascular dementia, Lewy body dementia, frontotemporal dementia, and several others. Problems with memory should be discussed with your doctor so that any reversible cause can be found and treated, or so that treatment for Alzheimer’s or dementia can begin as soon as possible if this is the cause.
Two Common Classes Of Drugs Have Been Linked To Dementia Fortunately There Are Alternatives To Both
If you’re worried about developing dementia, you’ve probably memorized the list of things you should do to minimize your riskeating a healthy diet, exercising regularly, getting adequate sleep, and keeping your mind and soul engaged. In addition, some of the drugs you may be taking to help you accomplish those things could increase your risk of dementia. In two separate large population studies, both benzodiazepines and anticholinergics were associated with an increased risk of dementia in people who used them for longer than a few months. In both cases, the effect increased with the dose of the drug and the duration of use.
These findings didn’t come entirely as a surprise to doctors who treat older people. The Beer’s List published by the American Geriatrics Society has long recognized benzodiazepines, antihistamines, and tricyclic antidepressants as potentially inappropriate for older adults, given their side effects. Such drugs are on the list because they share troubling side effectsconfusion, clouded thinking, and memory lapsesthat can lead to falls, fractures, and auto accidents.
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Reminiscence And Life Story Work
Reminiscence work involves talking about things and events from your past. It usually involves using props such as photos, favourite possessions or music.
Life story work involves a compilation of photos, notes and keepsakes from your childhood to the present day. It can be either a physical book or a digital version.
These approaches are sometimes combined. Evidence shows that they can improve mood and wellbeing. They also help you and those around you to focus on your skills and achievements rather than on your dementia.
You’ll find more details about these treatments in the Alzheimer’s Society’s dementia guide.
Risky Medications That I Pay Particular Attention To
According to the John A. Hartford Foundation, the 2019 AGS Beers Criteria includes 30 individual medications or medication classes to avoid for most older people, and 40 medications/medication classes to use with caution or avoid when living with certain diseases/conditions.
Everything in the Beers List is important, but in truth, some medications on the list feel much more relevant to me than others.
Thats because some of these medications are widely used by lots of older adults, most of whom have no idea they are taking a potentially inappropriate medication. Whereas other medications, such as barbituates, are on the list but are hardly ever used any more.
So, without copying too much out of the Beers Criteria, heres a brief list of the risky medications that I consider especially relevant to most older adults:
- The 4 types of medications that affect brain function. These are listed in depth in my article on this topic, and are also included in the 2019 AGS Beers Criterias Table 3, in the list of medications to avoid in people with dementia or cognitive impairment. They should also be avoided when older people have delirium. They are:
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Common Causes Of Sleep Problems In Older Adults
1. Sleep problems due to an underlying medical problem. Although older adults do often suffer from whats called primary sleep disorders, many sleep problems they experience are secondary sleep problems, meaning they are secondary to an underlying medical condition whose main symptoms are not sleep related.
Common health conditions that can disrupt sleep in older adults include:
- Heart and lung conditions which affect breathing, such as heart failure and chronic obstructive pulmonary disease
- Gastroesophageal reflux disease, which causes heartburn symptoms and can be affected by big meals late at night
- Painful conditions, including osteoarthritis
- Urinary problems that cause urination at night this can be caused by an enlarged prostate or an overactive bladder
- Mood problems such as depression and anxiety
- Neurodegenerative disorders such as Alzheimers and Parkinsons
- Medication side-effects
If an older person is having difficulty sleeping, its important to make sure that one of these common conditions isnt contributing to the problem. Treating an underlying problem such as untreated pain at night can often improve sleep. It can also help to talk to a pharmacist about all prescription and over-the-counter drugs, to make sure that these arent contributing to insomnia.
Alzheimers and related dementias pose special considerations when it comes to sleep, which I write about in this post: How to Manage Sleep Problems in Dementia.