In any case, the woman at the end of 60 seemed to suffer from severe dementia. It was largely incoherent. Her short-term memory was terrible. She could not focus on questions that medical professionals asked her.
But Malaz Boustani, a physician and professor of aging research at the Indiana University School of Medicine, suspected that something else might have happened. The patient took Benadryl for seasonal allergies, another antihistamine for itching, Seroquel (an antipsychotic) for mood swings, and urinary incontinence and gastrointestinal disorders.
Each of these drugs blocks to varying degrees an important chemical messenger in the brain, acetylcholine. Boustani believed that the cumulative effect could cause the woman's cognitive difficulties.
He was right. Within six months, Boustani and a pharmacist removed the medication from the patient and replaced alternative treatments. Miraculously, she seemed to recover completely. Her initial score in the Mini-Mental State exam was 1
An estimated 1 in 4 older adults take anticholinergics – a broad range of drug class for treatment from allergies, insomnia, leaking blisters, diarrhea, dizziness, motion sickness, asthma, Parkinson's, chronic obstructive pulmonary disease and various psychiatric disorders.
Older adults are very susceptible to negative reactions to these drugs. Since 2012, anticholinergics have topped the list of drugs that may be unsuitable for seniors from the American Geriatrics Society's Beers Criteria (beers).
"The medicines I'm most worried about in my clinic when I think about what might happen Anticholinergics contribute to the memory loss or cognitive changes in older patients," said Rosemary Laird, geriatrician and medical director the Maturing Minds Clinic at AdventHealth in Winter Park, Florida.
Here's what older adults should know about it Medication:
Anticholinergics work against, among others, acetylcholine, an important chemical messenger in the parasympathetic nervous system that dilates blood vessels and regulates muscle contractions, body secretions and heart rate. Acetylcholine plays an important role in the brain in attention, concentration and memory formation and consolidation.
Some medications have strong anticholinergic properties, others less. High potency prescription medicines include antidepressants such as imipramine (brand name trofanil), antihistamines such as hydroxyzine (Vistaril and Atarax), antipsychotics such as clozapine (Clozaril and FazaClo), antispasmodics such as dicyclomine (bentyl) and antinuclear medications called tolterodine (Detrol).
In addition to prescription drugs, many over-the-counter medicines have anticholinergic properties, including antihistamines such as Benadryl and Chloro-Trimeton, and hypnotics such as Tylenol PM, Aleve PM, and Nytol.  Common side effects include dizziness, confusion, drowsiness, disorientation, restlessness, blurred vision, dry mouth, constipation, difficulty urinating and delirium, sudden and acute changes in consciousness.
Unfortunately, physicians in the elderly often write anticholinergic symptoms to people aging or age-related illnesses rather than the effects of medications, "according to a study by physicians at the Medical University of South Carolina and the UK.
Seniors are more susceptible to the side effects of these drugs for several reasons: Their brain processes acetylcholine less efficiently. It is more likely that the drugs will cross the blood-brain barrier. And her body takes longer to break down these medicines.
In the late 1970s, researchers found that deficiencies in an enzyme that synthesized acetylcholine were present in the brains of people with Alzheimer's disease.
"This has alerted geriatricians and neurologists alike, and the word went out: Elderly adults, especially people with cognitive dysfunctions, should not be given drugs with acetylcholine blocking effects," said Steven DeKosky, neurologist and deputy director McKnight Brain Institute at the University of Florida.
Experts, however, believed that the effects of anticholinergics are short-term, and that when older patients stop taking them, "that's it – all normal," Boustani said.
Concerns in the mid-2000s, when researchers discovered signs that anticholinergics might have a long-term effect, possibly leading to the death of brain neurons and accumulation of plaques. Entrapment associated with neurodegeneration.
Several studies have since identified an association between anticholinergics and an increased risk of dementia. At the end of June, this risk was highlighted in a new report in JAMA Internal Medicine, which looked at more than 284,000 adults aged 55 and over in the UK between 2004 and 2016.
The study found that at least more than half of these subjects had been prescribed one of 56 anticholinergics. (These medications have been prescribed multiple times.) Individuals who took a daily dose of a potent anticholinergic drug for three years had a 49% increased risk of dementia. Most pronounced was the effect in subjects taking anticholinergics, antidepressants, antipsychotics, antiepileptic drugs and bladder control drugs.
These results are no proof that anticholinergics induce dementia. they only show an association. Based on this study and previous research, according to Boustani, older adults who take strong anticholinergic drugs for one to three years appear to be susceptible to long-term side effects.
Attention is focused on getting the best older adults off anticholinergics, and whether this could improve cognition or prevent dementia.
Researchers at Indiana University's School of Medicine hope to answer these questions from this fall in two new studies funded with $ 6.8 million National Institute for Aging.
344 elderly adults taking anticholinergic drugs and whose cognition is slightly impaired are included. A pharmacist will work with these patients and their doctors to rid them of the drugs, and patients' cognition will be reviewed every six months for two years.
The goal is to find out if the patient's brain is "getting better," said Noll Campbell, a scientist at Indiana University's Regenstrief Institute and assistant professor at Purdue University's College of Pharmacy. In this case, this would provide evidence that anticholinergic drugs cause a cognitive decline.
The second study, involving 700 older adults, examined whether an app that educates seniors about potential harms associated with anticholinergic drugs and establishes a personalized risk assessment for dementia induction causes people to talk to doctors about stopping these medications want to start.
In order to free patients from anticholinergic drugs, medication must last for at least three to six months, said Nagham Ailabouni, a geriatric chemist at the University of Washington School of Pharmacy. In most cases, good treatment alternatives are available.
Advice for Older Adults
Seniors who are concerned about taking anticholinergics "need to speak to their family doctor about the risks compared to the benefits of taking these medicines," said Shellina Scheiner, assistant professor clinical geriatric pharmacist at the University of Minnesota.
Do not try to stop cold turkeys or on your own.
Dizziness, confusion and nervousness, "said Ailabouni. "You can do that, but you have to work with a doctor."
Also, "Do not assume that an over-the-counter drug, if it's available [a]is automatically safe for your brain," Boustani said said. In general, he advises older adults to ask doctors how all the medications they take may affect their brains.
Finally, doctors should not give people with dementia anticholinergic drugs, DeKosky said. "Not only will this disrupt her memory, but it will probably confuse her and interfere with her functioning."
This column is edited by Kaiser Health News, an independent news service not affiliated with Kaiser Permanente.