Picture an older woman whose memory has been slipping. She often misplaces her keys. She has trouble recalling names. And occasionally she forgets to take the medications lined up on her nightstand. What’s going on?
If you’re like many people, you may dismiss these changes as “senior moments” or wonder if they could be signs of a health condition. But if you’re a doctor or pharmacist, you might also wonder what’s in those pill bottles by her bed.
A variety of medications can cause memory problems and impaired thinking as side effects. Among the biggest culprits are drugs with strong anticholinergic effects. That means they block one of the chemicals that brain cells use for communication. Drugs that act this way in the brain are used to treat allergies, painful bowel spasms, loss of bladder control and more.
Recently, however, experts have raised concerns about these medications. In one study published in the journal Neurology, researchers tracked the health of nearly 700 older adults for 10 years. Taking anticholinergic meds was tied to a faster decline in memory and language. And the link was strongest in those with genetic and biological risk factors for Alzheimer’s disease.
Which Meds May Cause Problems?
Below are some examples of medications with anticholinergic effects:
- Amitriptyline (Elavil) and imipramine (Tofranil), which are antidepressants
- Chlorpheniramine (AllerChlor, Chlor-Trimeton) and diphenhydramine (Benadryl), used for allergies
- Dicyclomine (Bentyl), used for irritable bowel syndrome
- Oxybutynin (Ditropan) and tolterodine (Detrol), used for bladder control problems
- Trihexyphenidyl (Artane), used for Parkinson’s disease
These drugs impact how brain cells talk to each other. At times, that may lead to memory problems and confusion. Other possible effects include a dry mouth, blurry vision, constipation and, in men, trouble with urinating.
And then there is the possible link to faster mental decline as people age. The Neurology study isn’t the only one to suggest such a connection. Another study, published in JAMA Internal Medicine, included more than 58,000 dementia patients ages 55 and older. Researchers compared them with healthy individuals of the same age and sex. They found that several kinds of anticholinergic drugs were associated with an increased risk for dementia.
These studies have focused on middle-aged and older adults for a reason: As people get older, they’re more likely to take multiple medications. This increases the chance of having side effects. Age-related changes in the structure and function of the brain may raise the risk for brain-based side effects even more.
The upshot is that anticholinergic drugs may become riskier as you grow older. Yet they are still commonly prescribed to older patients: About 5 to 6% of all provider visits for patients ages 65 and older result in a prescription for some type of anticholinergic medication.
What to Discuss with Your Provider
Just because a drug is listed above doesn’t mean it’s the wrong choice for you. But it does mean you should have a conversation with your health care provider. Discuss over-the-counter medicines as well as prescription ones.
Ask about both the expected benefits and the possible risks of your medication. You may want to specifically ask whether it could affect your memory and thinking. That’s especially important if you are age 65 or older (or if the medication is for a relative that age). Keep in mind that the more different meds you take, the higher your risk may be of having a bad reaction.
If you’re taking one or more of these meds and start having new memory problems, tell your provider. In some cases, you may be able to switch to a different medication or a nondrug treatment. But don’t just stop your medication suddenly without talking to your provider first. That could be a prescription for trouble.
Sources: Health in Aging Foundation, American Geriatrics Society, Journal of the American Geriatrics Society, JAMA Internal Medicine, Neurology, National Institutes of Health, American Journal of Psychiatry, Journal of the American Geriatrics Society, Institute on Aging, National Institutes of Health