Don’t Be Baffled by Brain Fog

Call it what you will, “brain fog,” “senior moment,” “cognitive decline,” or just plain confusion, the inability to think clearly can be devastating. It affects not only the person who is befuddled, but also his family and friends.
When an older person starts forgetting appointments or has difficulty balancing a checkbook, people may assume that old age is setting in. That can happen, but sometimes the problem lies with medication.
A reader shared this experience: “Many years ago my urologist prescribed Ditropan, and I took it 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. I’d arrive at work with my mind in a fuzzy state. When I picked up my refill at the pharmacy, I read about the side effects of the drug.
“I saw that my symptoms might be connected to the drug. I stopped taking it immediately and decided I would try to control my bladder some other way (exercises, etc.). My mental symptoms went away and I have not had any cognitive problems since. I still cope with bladder issues but I would rather be clear-headed.”
Medications to control overactive bladder include fesoterodine (Toviaz), oxybutynin (Ditropan) and tolterodine (Detrol). They are all classified as anticholinergic drugs. That means they can interfere with the way a neurochemical called acetylcholine functions in the body. This compound is essential for nerve communication and plays a crucial role in memory.
Dozens of other drugs also have anticholinergic activity. A new study (Journal of the American Geriatrics Society, online June 24, 2011) suggests that such medications increase the risk for cognitive impairment and mortality.
Anyone who would like a list of drugs with anticholinergic activity and a discussion of medications seniors should avoid may find our Guide to Drugs and Older People of value.
Anticholinergic drugs are not the only medicines that may mess with memory. We have heard from many readers that their cholesterol-lowering drugs may also have a negative impact. Here is just one such story: “I am a government attorney and handle some very complicated cases. I took Lipitor several years ago and started having great difficulty recalling information (both long-term and short-term memory loss) at work and at home. My wife commented on how forgetful I had become.
“I read some anecdotal research (from the University of California, San Diego) that confirmed what I suspected: other people on Lipitor also were suffering memory loss. I then spoke to my family clinic’s pharmacist, who told me that Lipitor ‘crosses brain waves.’ That was enough for me.
“My family doctor prescribed pravastatin instead. I won’t pretend I never forget anything, but I am out of the Lipitor Twilight Zone and my LDL cholesterol numbers are great.”
While age alone can contribute to cognitive decline, older people may be especially vulnerable to the effects of medicines. A specialist should assess the drug regimen of any older person experiencing mental fog.