Forgetfulness or Worse: Are Medications Raising Your Risk for Dementia?

Baby boomers are getting old. This is the generation that was born between 1946 and 1964. In five short years they will all be over 65. There are more than 70 million of them and many are starting to become forgetful. Others are showing clear signs of Alzheimer’s disease (AD). To avoid this dreaded mind slayer, health professionals are recommending that you should exercise regularly, eat healthy food, control your blood pressure, blood sugar and body weight and interact with friends and family. That’s all good advice, but it leaves out one essential element: you should try to avoid drugs that might be raising your risk for dementia.

A Generation of Drug Takers:

The baby boomers have been exposed to far more drugs than their ancestors. I am not just referring to marijuana. Although this is the generation that grew up during the era of “sex, drugs and rock & roll,” many are now living with arthritis, hypertension and high cholesterol.

Watch any television and you will see a never-ending stream of pharma ads for drugs like Jardiance for diabetes, Skyrizi for plaque psoriasis, or Rinvoq for rheumatoid arthritis. This is the generation that has apparently traded in weed for Wegovy.

OTC and Prescription Medications That May Be Raising Your Risk for Dementia:

What if we told you that a shocking number of drugs appear capable of raising your risk for dementia? People who want to dodge cognitive decline should avoid medications that might interfere with brain function.

A systematic review of the medical literature was published in the journal Translational Research & Clinical Interventions (Jan. 21, 2025). The authors reviewed 14 studies containing medical records for 130 million people. There were one million cases of dementia in this database.

What the authors discovered is disconcerting. There were some fairly predictable associations, such as drugs for neurodegenerative diseases or symptoms of dementia. Others were unexpected.

A possible connection between digestive distress and dementia is unclear, for example, but several medicines used to treat acid reflux, constipation or nausea were associated with a later chance of a dementia diagnosis. Pain relievers, anticonvulsants, drugs used to treat anxiety or insomnia and those for urinary problems were also linked to an elevated risk for cognitive difficulties.

Many people take anticonvulsant drugs such as gabapentin to treat a variety of disorders. They include nerve pain, back pain, postsurgical pain, pain after a shingles attack, sciatica, migraines, insomnia, bipolar disorder and so much more. There is a concern that gabapentin and a related drug, pregabalin, might pose an increased risk of dementia (Frontiers in Pharmacology, May 30, 2023).

What About Anticholinergic Drugs Raising Your Risk for Dementia?

One category of medications that stood out in the analysis published in Translational Research & Clinical Interventions (Jan. 21, 2025) is anticholinergic bladder drugs. These medications are frequently prescribed for “overactive bladder.” They don’t simply affect the urinary tract, though.

Anticholinergic drugs interfere with the neurochemical acetylcholine (ACh) that plays a key role in memory. It is not surprising, therefore, that such medications might be associated with cognitive dysfunction (Drugs & Aging, April 2020).

Many baby boomers now complain about “overactive bladder.” That’s when someone experiences a sudden urge to urinate. It can be challenging to postpone the need to pee. There are now a number of medications being prescribed for this concern. There is even one (oxybutynin) that is available without a prescription.

A British study published in BMJ Medicine (Nov. 12, 2024) describes a worrisome association.

The authors introduce their research this way:

“Prolonged treatment with anticholinergic drugs has been linked to long term cognitive decline and dementia, and is a potentially modifiable risk factor. Several studies have found a strong longitudinal association between the use of anticholinergic drugs used to treat bladder symptoms in older adults and the risk of dementia. Despite this finding, use of these drugs nearly doubled in older adults in England over the past 20 years.”

Conclusions:

“In this study, we found that of the different anticholinergic drugs used to treat an overactive bladder, oxybutynin hydrochloride, solifenacin succinate, and tolterodine tartrate, were most strongly associated with an increased [risk] of dementia in older adults. This finding highlights the need for clinicians to take into account the possible long term risks and consequences of the available treatment options for an overactive bladder in older adults, and to consider prescribing alternative treatments that might be associated with a lower risk of dementia.”

Some Antihistamines Also Have Anticholinergic Activity:

Bladder drugs are not the only pharmaceuticals that impact neurons that rely on ACh. Antihistamines such as diphenhydramine (DPH) are notorious in this respect. Millions of people take DPH every night because this ingredient is now found in so many nighttime “PM” pain relievers.

There are dozens of other drugs with significant anticholinergic activity. Older antidepressants such as amitriptyline are sometimes prescribed to help people sleep because they are sedating. But this drug is considered potentially inappropriate for older people. So is paroxetine (American Journal of Geriatric Psychiatry, Aug. 2019).

You can find a comprehensive list of anticholinergic drugs at www.PeoplesPharmacy.com. Just search “list of anticholinergic drugs.” You will be surprised at how long this list is and so will your health care provider.

Some Allergy Drugs that Might Be Raising Your Risk for Dementia:

Here are some headlines that sound like they could be hype:

“Hay-fever drugs linked to Alzheimer’s” (Irish Independent)

“Over-the-counter pills could raise risk of Alzheimer’s: study” (New York Post)

“Common allergy, depression meds may increase odds of dementia” (CBS NEWS)

“Dementia ‘linked’ to common over-the-counter drugs” (BBC News Health)

These headlines are scary. Should you be concerned? We think so. As you will see, these concerns go back many years.

The ACT Study of Anticholinergics and Dementia:

For decades, researchers studied participants in the Adult Changes in Thought (ACT) study conducted in the Seattle area (JAMA Internal Medicine, online, Jan. 26, 2015). These were older people enrolled in an integrated health care delivery system called Group Health. Over 3,000 individuals were included in the research, and none had dementia when they entered the study starting in 1994.

Scientists tracked their drug use and cognitive function over the next two decades. The higher the dose of anticholinergic drugs and the longer such medications were taken, the greater the risk of dementia. In this study, the most common anticholinergic drugs were antihistamines found in over-the-counter allergy drugs and nighttime pain relievers, antidepressants that are also prescribed for nerve pain and medications prescribed to treat incontinence or symptoms of overactive bladder.

The authors conclude:

“Higher cumulative anticholinergic use is associated with an increased risk for dementia. Efforts to increase awareness among health care professionals and older adults about this potential medication-related risk are important to minimize anticholinergic use over time.”

The Evidence Keeps Accumulating:

In the BMJ (formerly the British Medical Journal), an article published on April 25, 2018 reinforced the relationship between anticholinergic drugs and dementia.

The authors concluded:

“Many people use anticholinergic drugs at some point in their lives, and many are prescribed to manage chronic conditions leading to potentially long exposures. There are robust associations between levels of anticholinergic antidepressants, antiparkinsons, and urologicals and the risk of a diagnosis of dementia up to 20 years after exposure.”

A Short History of Anticholinergic Medications?

We have been writing about this category of drugs for a very long time because of a clearly established link to cognitive impairment. These medicines are known as anticholinergics because they interfere with the ability of a crucial brain chemical called acetylcholine (ACh) to attach to nerve cells. ACh is essential for muscle contraction. Without adequate amounts of this neurotransmitter you could not breathe, blink your eyes or tie your shoelaces. Body movement can only happen when ACh triggers a muscular contraction.

Acetylcholine is also critical for proper brain function. Without ACh doing its job transmitting messages between brain cells, you would become forgetful and confused.

Twilight Sleep for “Painless Childbirth”

One of the most potent anticholinergic medications, scopolamine, was used for decades with a narcotic like morphine to induce “twilight sleep.” Starting about a century ago, women were given this combo during labor and delivery so they wouldn’t remember the pain or anything else about the experience.

The German researchers who developed this approach in the early 20th century said that it produced:

“clouded consciousness with complete forgetfulness.”

Are Modern-Day Anticholinergics Raising Your Risk for Dementia?

Most physicians are offered a few hours of training about anticholinergic drugs (at best). They are taught about belladonna, aka deadly nightshade. (The drugs atropine, hyoscyamine and scopolamine were derived from the plant Atropa belladonna.) Such medications have been used to treat diarrhea and what was once called “spastic colon.” The combination of atropine and diphenoxylate (Lomotil) remains popular for diarrhea.

Scopolamine (Transderm Scop) is still prescribed for motion sickness, and ophthalmologists and optometrists may use atropine drops to dilate the pupils during an eye exam. Doctors also employ other anticholinergic drugs such as ipratropium (Atrovent) and tiotropium (Spiriva) for asthma. Anticholinergics such as fesoterodine (Toviaz), oxybutynin (Ditropan) and tolteradine (Detrol) are frequently utilized to control the symptoms of overactive bladder.

Popular Antihistamines & Sleep Aids:

What most modern-day physicians have not learned, however, is that many other drugs also have anticholinergic activity. As mentioned in the ACT study, first-generation antihistamines were linked to dementia. We are talking about drugs like chlorpheniramine and diphenhydramine (DPH).

You may be surprised where DPH shows up. It is the primary ingredient in many allergy and hay fever meds, including the popular brand name Benadryl. But DPH is also found in a huge number of nighttime pain relievers and sleeping pills. Look at the label of Advil PM, Aleve PM, Bayer PM, Excedrin PM, Nytol, Simply Sleep, Sominex, Tylenol PM or Unisom and you may find diphenhydramine as a key ingredient.

We do not worry very much about the occasional use of such drugs. But chronic use, day in and day out for both pain and insomnia, begins to add up to substantial anticholinergic exposure. That is especially true if these drugs are used year in and year out.

Are Anti-Anxiety Agents Raising Your Risk for Dementia?

Antianxiety agents and sleeping pills may also pose a risk for older people. Benzodiazepines such as alprazolam, diazepam, flurazepam or lorazepam have been prescribed for decades to help people overcome insomnia. Prolonged use of such medications may be associated with cognitive decline (International Psychogeriatrics, Dec. 2024).

Here are the authors’ conclusions:

“This is the first systematic review to examine the cognitive impact of multiple psychotropic drug classes in older adults over an extended follow-up period (six months or more) using robust sample sizes, drug-free control groups, and validated cognitive instruments. We found evidence to indicate cognitive decline with the cumulative use of benzodiazepines and the use of antidepressants, especially those with anticholinergic properties among older adults without cognitive impairment at baseline. Further, the use of antipsychotics and psychotropic combinations is also associated with cognitive decline in older adults.”

Stopping any medications can be challenging, though. That’s especially true for benzodiazepines. People taking drugs that might increase the risk of dementia need to ask the prescriber for assistance. If the medication can be discontinued, it may need very gradual tapering to prevent unpleasant withdrawal symptoms.

Here’s the Real Problem:

What concerns us far more than any individual anticholinergic medication is the combination of several drugs with anticholinergic activity. Physicians may not realize that the anti-anxiety agent alprazolam (Xanax) has anticholinergic activity. So does the ulcer drug cimetidine (Tagamet). The dizziness drug meclizine (Antivert, Bonine) also has this activity.

We could go on and on, but by now you get the picture. There are dozens of medications that have this property. Someone taking Tylenol PM to get to sleep who is also taking amitriptyline to ease nerve pain along with oxybutynin to control an overactive bladder could end up disoriented and forgetful. But don’t take our word for it. Here are stories from visitors to this website:

C.S. writes:

“Many years ago my urologist prescribed Ditropan and I took the drug for about four years. I had an hour’s drive to work each day and I began to realize that many days I could not remember the drive and would arrive at work with my mind in a somewhat “fuzzy” state. I happened to pick up a new prescription for Ditropan at the pharmacy and started reading the side effects of the drug.

“I saw that my symptoms could be connected to the drug. I stopped taking the drug immediately and decided that I would try to control my bladder some other way (exercises, etc). My symptoms went away and I have not had any problems since. I still cope with bladder issues but I would rather be clear-headed.”

Robert adds:

“I was prescribed amitriptyline for headaches and couldn’t stop sleeping! I also felt sluggish mentally and pretty much dead overall. It was an awful feeling.”

This comment comes from Abigail:

“I appreciate your warning about anticholinergics. I only took Lomotil for IBS [irritable bowel syndrome] when I went out for an event, so I thought my episodes of brain confusion were caused by senior moments. After your warning I realized I was taking an anticholinergic. I stopped taking Lomotil and have regained my mental clarity. Thank you!

Who Takes an Anticholinergic Drug?

You might wonder how many older people are on anticholinergic medications. According to the Seattle team of researchers, 8% to 37% are taking such drugs, despite warnings to health professionals that risks might outweigh benefits. In other words, as many as one-third of people over 65 could be taking an anticholinergic drug without even knowing it.

The authors of the study point out that this may not be reversible:

“The general view is that anticholinergic-induced cognitive impairment is reversible on discontinuation of medication therapy. However, several investigators have reported that anticholinergics may be associated with an increased risk for sustained cognitive deficits, such as mild cognitive impairment or dementia. One biologically plausible mechanism for these findings is that cumulative use of these agents results in pathologic changes in the brain similar to those observed with Alzheimer disease (AD).”

Most Doctors Don’t Know Which Drugs Are Anticholinergic:

As mentioned earlier, medical students get an hour or two of training about anticholinergic medicines. They learn about atropine, hyoscyamine and scopolamine, classic drugs in this category.

What they don’t always learn is how many other medications also have anticholinergic activity. If you ask your doctor whether cimetidine (Tagamet), furosemide (Lasix) or alprazolam (Xanax) could have anticholinergic action, the chances are pretty good that you would be told no. But the list of such drugs is surprisingly long.

Learn More!

Here is a link to a list that we have prepared. We must emphasize that no one should EVER discontinue any drug without first checking with the prescriber!

That said, the Seattle team of researchers suggests that:

“Prescribers should be aware of this potential association [the increased risk for dementia in people with higher-use of anticholinergic drugs] when considering anticholinergics for their older patients and should consider alternatives when possible. For conditions with no therapeutic alternatives, prescribers should use the lowest effective dose and discontinue therapy if ineffective.”

Would you like to know more about how medications can affect brain function? We have much more information in our chapter, “The Screwing of Senior Citizens.” In addition to a list of anticholinergic drugs, there is a long list of medications that older people should generally avoid (The Beers List). This information can be found in our book, Top Screwups Doctors Make and How to Avoid Them.

Contradictory Studies Create Confusion!

Health professionals and patients love clarity. Elevated blood sugar levels lead to diabetes and that is bad news. A high fever usually indicates an infection that can be dangerous. Aspirin can be irritating to the stomach. These observations are not controversial.

Many of the topics we cover here on The People’s Pharmacy are confusing, contradictory and even contentious. That is especially true when it comes to things that may be raising your risk for dementia. What are doctors and patients supposed to do when studies disagree?

Heartburn Drugs and Dementia? The Headlines Are Worrisome:

A study published in a highly respected journal (Neurology, Aug. 9, 2023) created scary headlines:

“Long-Term Use of Some Acid Reflux Drugs Linked to 33% Higher Dementia Risk” (Psychiatrist.com)

“Long-term use of certain reflux medications is associated with a higher risk of dementia, study suggests” (CNN)

“Popular heartburn medicine may increase dementia risk by 33%” (USA Today, Aug. 9, 2023)

“Long-term use of acid reflux medications linked to higher dementia risk” (Washington Post)

What Did the Researchers Discover about PPIs Raising Your Risk for Dementia?

The investigators recruited more than 5,700 people who did not have dementia at the start of the study. Those who used a PPI for more than 4.4 years:

“…were at a 38% higher risk of developing dementia in later life.”

In the spirit of transparency we must point out that this is an association, not proof of causation. Let’s drill a bit deeper, though.

Here is the authors’ introduction to this research:

“Proton pump inhibitors (PPIs), available via prescription and over-the-counter, are currently the first-line therapy for the short-term treatment (4 to 8 weeks) of gastroesophageal reflux disease (GERD) and peptic ulcers. In a study based on U.S. emergency department visits, PPI use increased from 4% to 9% from 2002 to 2009. PPIs were dispensed over 115 million times in 2016. Additionally, up to 63% of PPI prescriptions did not have a documented gastrointestinal diagnosis and may have been inappropriately prescribed. Long-term use of PPIs has not been approved; nevertheless, chronic PPI use is common.

“Chronic PPI use has been linked to numerous health conditions such as stroke, cardiovascular disease, chronic kidney disease, and dementia. Previous studies on the relationship between PPI use and dementia report mixed results.”

Conflicting Results Regarding PPIs Raising Your Risk for Dementia:

When South Korean scientists analyzed nationwide records over the decade between 2002 and 2013, they concluded that older heartburn drugs such as famotidine were just as likely to be linked to dementia as PPIs (Drug Safety, June 2018).

They concluded:

“The risk of PPIs being associated with dementia may be overestimated.”

Even more confusing, a few meta-analyses have looked at the results from several trials and found no significant association between PPI use and dementia (Diseases of the Esophagus, Oct. 2020). A meta-analysis of observational studies found that the risk of dementia increased by 16 percent, a nonsignificant amount, for PPI users (British Journal of Clinical Pharmacology, Feb. 2023).  According to the authors, their study does not provide clear evidence for an association between PPI use and dementia.

Why Don’t We Know if PPIs Could Be Raising Your Risk for Dementia?

Researchers have been worried about the possibility of PPIs raising your risk of dementia since 2010 (Journal of Clinical Pharmacology and Therapeutics, April 2010). From where we sit, it feels a bit like a seesaw going up and down or a pendulum swinging back and forth. Some systematic reviews of clinical trials say don’t worry.

But then along come other studies that reinforce the risk. For example, scientists analyzed the medical records of more than 73,000 older Germans over seven years (JAMA Neurology, April 2016). Those who took PPIs long term were 44 percent more likely to get a new dementia diagnosis by the end of the study.

The authors concluded:

“The avoidance of PPI medication may prevent the development of dementia. This finding is supported by recent pharmacoepidemiological analyses on primary data and is in line with mouse models in which the use of PPIs increased the levels of β-amyloid in the brains of mice. Randomized, prospective clinical trials are needed to examine this connection in more detail.”

Now you understand why this issue is so confusing. The very first PPI, Prilosec, was approved by the FDA in 1989. Even after 30 years, we do not have a comprehensive understanding of the risks of this powerful class of medications taken by millions of people on a daily basis.

Instructions for over-the-counter PPIs like Nexium and Prilosec are quite clear:

“Do not use for more than 14 days unless directed by your doctor. You may repeat a 14-day course every 4 months. Do not take for more than 14 days or more often than every 4 months unless directed by a doctor.”

We think that is very good advice!

Are Your Drugs Raising Your Risk for Dementia?

Lest you think this is only an older person’s problem, we hasten to point out that middle-aged and younger people can also experience anticholinergic side effects. Just because you are 57 does not mean you are immune to these complications.

Health professionals need to be far better educated about anticholinergic pharmacology and its consequences on the brain. And patients need to ask their physicians, nurse practitioners and pharmacists whether any of their medicines have anticholinergic activity. And let’s not forget the controversy swirling around proton pump inhibitors (PPIs).

Final Words:

You might think that the FDA would be concerned about the issue of drugs and dementia. Our sense is that this is not a priority. Swedish researchers note that “Cognitive Safety is Largely Ignored in Clinical Drug Trials (Drug Safety, Jan. 2024).

Here are their observations:

“The number of reports on suspected drug-induced memory impairment submitted to the US Food and Drug Administration increased 30-fold from 2000 to 2022. Drugs are the most common cause of reversible dementia. However, there is very little research on drug-induced cognitive impairment. The aim of this study was to investigate if and how an assessment of cognitive safety was included in recent, registered, controlled, clinical drug trials.

“Conclusions: Cognitive safety is largely ignored by recent controlled clinical trials. This applies even to trials assessing new drugs and trials assessing central nervous system drugs. There is an urgent need for drug manufacturers, regulatory authorities, and the medical profession to address the cognitive safety of drugs.”

Please share your own story below in the comment section.

If you appreciate this information, you may wish to share it with friends and family by scrolling to the top of the page and clicking on the icons for email and/or social media. Because this is a long article, you probably found the ads that are sprinkled throughout a bit disruptive. You can eliminate those ads by subscribing to our ad-free service. Look on the left hand column for “Browse website with no ads” for this option. It will cost $5/month, though.

If you find our free newsletter helpful, please encourage acquaintances to sign up at this link. It is the only way we can combat the challenges posed by Google’s ability to make our content virtually invisible to search.