With mounting evidence of a connection between dementia and anticholinergic drugs, you may be concerned about your own risk or a loved one’s medications. In this Q&A, geriatric pharmacist Gina Ayers, PharmD, BCPS, BCGP, explains what we know and what you can do about it.
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Q. Is there any evidence that anticholinergic drugs increase your risk for dementia?
A. There is evidence that certain medications — both prescription and over-the-counter — are associated with an increased risk of dementia. The latest study to confirm this connection came out in June 2019 in the Journal of the American Medical Association (JAMA). This large, robust study showed a definite link between anticholinergic medications and patients who have dementia, but it didn’t prove that there was a direct cause.
Given the known increased risk of dementia with certain medications, we try to get patients off of these medications, if possible. We have seen patients’ cognition improve as a result.
Q. What medications are associated with dementia risk?
A. The 2019 American Geriatric Society Updated Beers Criteria provides recommendations on medications that are potentially inappropriate in older adults. This criteria suggests that medications like anticholinergics and hypnotics should be avoided in patients with dementia if possible. Evidence suggests that these types of medications could contribute to or worsen dementia.
This broad category of medications includes drugs we use to treat urinary incontinence, depression, muscle spasms, and even allergies. Anticholinergic medications are also in products that you can buy over-the-counter.
Most over-the-counter medications for sleep or nighttime symptoms have diphenhydramine (Benadryl®), or a similar type of medication, which can affect cognition. When older adults with cognitive concerns are taking these medications, we talk to them about alternative treatments that do not affect cognition. Other examples of anticholinergic drugs include cyclobenzaprine (Flexeril®) and oxybutynin (Ditropan®).
These medications include benzodiazepines and medications like zolpidem (Ambien®). Doctors often prescribe them to help with sleep or anxiety. Fortunately, there are alternative agents that can be used. So when patients have dementia or problems with memory, we often try to substitute a different medication with fewer cognitive effects.
Other examples of these drugs include diazepam (Valium®), lorazepam (Ativan®), and alprazolam (Xanax®)
Q. How do anticholinergics affect dementia risk?
A. Anticholinergic drugs act by blocking acetylcholine, a chemical involved in nervous system functions. When the drugs block these functions in the brain, it can cause cognitive changes. As you age, you become more sensitive to the effects of these medications.
And although we don’t yet have proof that they cause dementia, we often find that patient’s cognitive function improves when they are no longer on these medications.
Q. Who is most at risk for adverse effects from these medications?
A. As you age, you can become more sensitive to the effects of these medications. And these medications may have cumulative effects. So if you’re on more than one of these medications or use them over a longer period of time, you might have even more risk of these side effects.
Q. If you’re someone who is taking these medications, what should you do?
A. We recommend you take these steps if you have any concerns:
- Speak to your doctor or geriatric team before you stop taking these medications: If you suddenly stop taking certain medications, you may experience worsening effects. Your provider can determine whether the medication should be tapered and may also be able to recommend safer substitutions you can use in their place or non-medication treatment options you can try.
- Be informed and ask questions: You may have been on a medication for years that you’ve tolerated well. But it’s fair to continually reevaluate your medications. Your body doesn’t metabolize and respond to medications the same way it did 30 years ago. So bring your questions to your provider to help start the conversation.
- Speak with your provider about any over-the-counter medications you’re taking: Those medications still can have side effects and may be doing more harm than good. You can either ask your geriatrician or your pharmacist.