Many people, including a lot of health professionals, are unaware how many medications have anticholinergic activity. Perhaps even more alarming are the complications from a big anticholinergic “burden.” The more medicines a person takes that have anticholinergic activity the greater the risk of side effects such as memory problems, as this reader discovered:
Q. Are there antidotes to anticholinergic drugs? I have taken Benadryl (diphenhydramine), Paxil (paroxetine) and oxybutynin (Ditropan) for years.
I have read that such drugs can affect the brain. I feel as though my memory is half gone.
I am 83 and had a very good brain and a high IQ. I am worried and hope there are ways to reverse my mental decline.
A. There is growing recognition that drugs affecting the brain chemical acetylcholine can impair mental function, especially in older people (JAMA Neurology, June 1, 2016). The medications you mention all have anticholinergic activity and could contribute to memory problems.
A Mediterranean Diet?
Your doctor may be able to reduce your exposure to this type of medication. Lowering the anticholinergic burden might possibly be helpful. Appropriate exercise and a Mediterranean diet may also benefit your brain. It may come as a surprise to learn that diet might be good for memory, but here is a review of the research: “Mediterranean Diet, Cognitive Function, and Dementia: A Systematic Review of the Evidence” (Advances in Nutrition, Sept. 15, 2016).
At age 83 we would not want you running or doing anything that might increase your risk for a fall. That said, many senior centers have safe exercise programs that can be done sitting down or in a swimming pool. Sometimes just using special exercise bands can improve muscle tone. And a daily walk can be beneficial.
The New Specialty of “Deprescribing”
Deprescribing:
The British Journal of Clinical Pharmacology (Nov. 4, 2015) proposed the following definition for deprescribing:
“Deprescribing is the process of withdrawal of an inappropriate medication, supervised by a health care professional with the goal of managing polypharmacy and improving outcomes.”
Wikipedia defines deprescribing this way:
“Deprescribing is the process of intentionally stopping a medication or reducing its dose to improve the person’s health or reduce the risk of adverse side effects. Deprescribing is usually done because the drug may be causing harm, may no longer be helping the patient, or may be inappropriate for the individual patient’s current situation.”
We think the Wiki definition hits the nail on the head. Medications that make us stupid or forgetful or increase our risk for dementia are likely to cause harm.
Identifying Potentially Harmful Drugs:
Geriatricians and those health experts who specialize in cognitive function have been advocating for medication audits to identify and deprescribe drugs with strong anticholinergic activity (Drug Safety, June, 2014). These authors note that 33 to 47% of older people who are admitted to hospitals are found to be taking such medicines. The researchers note that it is possible reduce anticholinergic drug exposure once such audits are undertaken.
Experts from Australia and New Zealand encourage deprescribing of anticholinergic drugs (Expert Opinion on Drug Safety, June, 2016). They state:
“…higher anticholinergic burden is a strong predictor of cognitive and physical impairments in older people. Anticholinergic burden is not only a concern related to long-term use of medicines with AA [anticholinergic activity] but short-term use as well. Anticholinergic exposure for as short as 2 weeks has shown to be associated with a decline in global cognitive function, visual memory, verbal fluency, and on activities of daily living.”
No one has done the research to determine if reducing the anticholinergic burden will reverse memory problems. These authors offer this expert opinion, however:
“It is postulated that minimizing anticholinergic burden in older people may result in improved short-term memory, confusion, behavior, and delirium together with an enhanced quality of life and daily functioning. Medicines with AA are to be best avoided in the geriatric population, unless considered clinically essential.”
A Collaborative Effort to Improve Memory Problems:
Here is a link to an expanded list of anticholinergic drugs. You may wish to bring it to your doctor’s attention.
Please let us know how you make out. You are not the only one to report that too many anticholinergic drugs can affect memory. Here are some comments from visitors to this website:
Donna in North Carolina shares a concern several others have also expressed:
“Atarax (hydroxyzine) and Benadryl (diphenhydramine) were routinely administered in the chemotherapy I received for breast cancer. After 5 months of chemo, I attributed my loss of mental function to a condition I read about called “chemo brain” — and chalked it up as another price paid in side affects for the benefit of staying alive.
“Because these two drugs were dispensed so often and so casually, I have taken them both since chemo, especially Benadryl, because I am allergic to certain insect bites, and because it can aid in sleep. The big-gun cancer drugs have caused organ damage, aging organs 20-25 yrs, I’d say. It may be that the anticholinergics are responsible for the most frustrating loss I have experienced! I remember reading about taking choline back in the 1970’s and wonder if that would be helpful for my memory.”
Aurie in Michigan offers an interesting observation:
“I have been taking allergy meds since I was just a child. I am now 78 years old. On top of that, I have been on many other anticholinergics over the years as well. Now I know why my memory problems are increasing! I truly believe the less drugs the better!
“Outside of Vitamin B-12 shots once every few months, my grandma did not take any prescription drugs and she lived to be 97. She also ate plenty of butter, cooked with lard and bacon grease. So there!”
Derborah in Brooklyn, MD:
“Wow. I have been thinking that I’ve lost my mind. Can’t remember stuff I did 5 minutes ago. My long term memory is so much better than the short term memory. No wonder. I take 5 of the medications on this list. I have got to get off of these meds. I just turned 57 and was thinking that I have early onset oldtimers!“
To see a list of drugs that are potentially problematic for senior citizens, check out our Guide to Drugs and Older People in our Health Guides.
To learn more about how to avoid medication misadventures in general you may find our book helpful: Top Screwups Doctors Make and How to Avoid Them.
