Tuesday, April 22, 2008

Commonly Used Prescriptions May Hasten Cognitive Decline in Elders

Jack Tsao, MD, DPhil, associate professor of neurology at Uniformed Services University, in Bethesda, Maryland, recently studied the effect of medications with anticholinergic properties on cognitive decline. The study was prompted by an elderly patient who presented with memory loss, yet did not fall within the normal parameters used to diagnose dementia or Alzheimer's disease. Kenneth Heilman, MD, from the University of Florida at Gainesville, who co-authored the study, noticed that this was his second patient who had begun treatment for overactive bladder and complained of memory loss.

According to Dr. Tsao: "Because Dr. Heilman had seen a previous case of another woman who had memory complaints that reversed after stopping her bladder medicine, we did the same for this lady, and her memory improved. This prompted us to ask the question of whether anticholinergic medicines or medicines that have anticholinergic properties actually can impair thinking in normal individuals".

Medications that contain strong anticholinergic properties include those used to treat Parkinson's disease, and drugs used to treat overactive bladder, such as Detrol, Warfarin, furosemide (Lasix), and Zantac have weak anticholinergic properties, in addition to the antihypertensive/fluid pill, HCTZ. Even medications, such Dramamine and Benadryl have an anticholinergic effect. Per Dr. Tsao: "When we actually looked through the literature, a lot of medicines that are not advertised as anticholinergic in nature actually have anticholinergic properties in vitro. He concluded that anticholinergic medications contribute to an increase in elderly cognitive decline.

Plans to further the study include involving patients who already have mild cognitive impairment to see if anticholinergic drugs make it worse. They also intend to investigate the link between cognitive decline and drug potency.

The results come from the American Academy of Neurology 60th Annual Meeting. Dr. Tsao suggests that physicians consider cognitive performance when prescribing medications with anticholinergic properties.

A 2006 study, published in the British Medical Journal also showed that elders who take anticholinergics fared more poorly on memory tests. Dr. Tsao suggests… “if someone is having what they feel is a noticeable problem with their ability to remember things, they need to go see their doctor. And they need to mention if they are on one of these drugs."

In addition, make certain that you understand all of your medications, including the side effects. Accept counseling from your pharmacist when new medications are prescribed. You should always carry a list of your medications, and keep it updated to show each of your healthcare providers. Never assume that communication between healthcare providers is current. If you are over age 65, you need to be especially cautious when taking any medication. Never be afraid to ask questions.

Source: American Academy of Neurology 60th Annual Meeting: Abstract S51.001. Presented April 17, 2008.