Taking Anticholinergic Medications Raises the Risk of Alzheimer's & Other Dementias

Older adults should read  the labels before buying 

over-the counter antihistamines and sleep aids.

An Annotated Bibliography Linking Anticholinergic Medications & the Risk of Developing Dementia 

Evelyn E. Smith

M. S. in Library Science, University of North Texas (2012)

When Shelly Gray and her fellow researchers at the University of Washington published a study linking the cumulative use of anticholinergic drugs and dementia in the January 2015 issue of the Journal of the American Medical Association Internal Medicine, this not only confirmed the results of earlier research, but it also excited much commentary on the adverse effects of widely used over-the counter drugs. However, this research is best reviewed in its historical context, which warrants an analysis of previous studies that have associated the use of prescription and over-the-counter medications that block the acetycholine transmitter with an increased risk of developing Alzheimer's and other dementias. However, physicians shouldn''t ask older adults to throw away their Sominex, Benadryl, and Oxybutynin without coming up  with some alternative remedies as well as asking their patients to disclose all the prescription and over-the-counter medications they are taking. At the very least, consumers should check to see if  the over-the-counter medications they are thinking of buying contain anticholimergic ingredients like diphenhydramine before purchasing an antihistamine to dry up a runny nose or a sleep aid to get a good night's sleep.

Campbell, Noll L. & Boustani, Malaz, A. (2015, January 26). Adverse cognitive effects of medications: Turning attention to reversibility. [Invited commentary]. JAMA Internal Medicine. doi: 10.1001/jamainternmed.2014.7667. {First page only]. Retrieved from http://archinte.jamanetwork.com/article.aspx?articleid=2091742

Shelly Gray and her colleagues at the University of Washington School of Pharmacy have published an observational analysis that equates a high risk of dementia with increasing doses and long-term use of anticholimergic drugs. Other studies also show similar results.  However, researchers haven't addressed the reversibility of these adverse cognitive effects (Campbell, 2015, January 26, para. 1). Admittedly, University of Washington researchers took special care to reduce recall and protopathic biases while relying on clinical diagnoses of dementia taken from consensus panels of experts (Campbell, 2015, January 26, para.2).

But in addition to recognizing anticholimergic drugs as inappropriate for older adults, the American Geriatric Association also recognizes the dangers posed when older adults take benzodiazepines and antihistamines, so the careful research methods that the University of Washington researchers applied to their analysis of the effects of anticholimergic medications on older adults should be applied to all medications with adverse cognitive side effects (Campbell, 2015, January 26, para.4).

Campbell and Boustani acknowledge that their own research has previously found a link between anticholimergics and Mild Cognitive Impairment after only accessing one year of pharmaceutical dispensing records and found results similar to Gray's study, although their research showed a stronger association between anticholimergic drugs and MCI, raising the possibility that their adverse effects might be reversed (Campbell, 2015, January 26, para. 5-6). They thus believed that “it makes clinical sense to minimize exposure to these medications among older adults”, even though no evidence—as yet--"supports the hypothesis that discontinuing improves cognitive ability (Campbell, 2015, January 26, para 8).

However, discontinuing these drugs also means that physicians must tailor treatments to fit each individual patient's needs. While completing a Randomized Clinical Trial would take the better part of two decades, clinical interventions might prevent the onset of dementia within a much shorter time period (Campbell, 2015, January 26, para 9).

Campbell, N. L. ,Boustani, M. A., & Lane, K. A., et al. (2010, July 13). Use of anticholinergics and the risk of cognitive impairment in an African American population. Neurology, 75(2), 152-159. doi: 10.121WNL.0b013e3181e712ab [Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2905930/

Researchers observed 1,652 “community-dwelling” African American over age 79 over a six-year period, who were enrolled in the Indianapolis-Ibadan Dementia Project, who at the beginning of this longitudinal study had normal cognitive functioning: 53 percent of this population had possibly taken anticholinergic drugs while 11 percent had definitely taken them. Researchers associated an increased risk of dementia with definite anticholinergic users of 1.46 percent while possible anticholinergic users didn't increase their risk of developing dementia. Furthermore, the risk of cognitive impairment increased for anticholinergic users if their weren't APOE ε4 allele carriers by 1.77 percent.

Carrière, Isabelle, Fourrier-Reglat, Annie, & Dartigues, Jean-François, et al. (2009, July 27). Drugs with antiicholinergic properties,cognitive decline, and dementia in an elderly general population: The 3-city study. Archives of Internal Medicine [JAMA Internal Medicine], 169 (14), 1317-1324. doi:10.1001/archintermed.2009.229. [Abstract for Free Article]. Retrieved from http://archinte.jamanetwork.com/article.aspx?articleid=224695&resultClick=3

Researchers evaluated 4,128 women and 2,784 men age 65 or older from three French cities, assessing cognitive performance as well as anticholinergic use at base line and then at two and four years later. 7.5 percent of the participants reported using anticholinergic drugs at baseline. Women who reported using anticholinergic drug use at the beginning of the study showed a decline in verbal fluency of 1.41 percent an global cognitive functioning of 1.41 percent over women not taking anticholinergic drugs. Men who reported using anticholinergic drugs experienced a decline in visual memory of 1.63 percent and executive function of 1.47 percent. Women who continuously used anticholinergic drugs experienced a steeper cognitive decline than those who had discontinued their use. Researchers therefore concluded that taking anticholinergic drugs increases the risk of cognitive decline and dementia while discontinuing their use decreases their rise. Accordingly, physicians should reconsider giving prescriptions of anticholinergic drugs to older adults.

Fox, Chris, Smith, Toby & Maident, Ian, et al. (2014, August 25).  Effect of medications with anti-cholinergic properties on cognitive function, delirium,physical function and mortality:  A systematic review.  Age and Aging.  British Geriatric Society. [Abstract only].  Retrieved from  http://ageing.oxfordjournals.org/content/early/2014/07/19/ageing.afu096

After reviewing 46 studying with 60,944 participants, researchers found that 77 percent of the studies reported a significant decline in cognitive function accompanied an increased anti-cholinergic load Four out of five studies, however, reported no link between an increasing anti-cholinergic load and delirium while five out of eight studies associated a decline in physical function with the use of anti-cholinergics. An increased in morbidity shown in three out of nine studies wasn't “statistically significant”.

Fox, Chris, Livingston, Gill, & Maidment, Ian D., et al. (2011). The impact of anticholinergic burden in Alzheimer's dementia. Age and Ageing, 40 (6), 730-735. British Geriatric Society. Medscape Multispecialty. Retrieved from http://www.medscape.com/viewarticle/752637

A sampling taken from July 2002 to January 2003 of 224 British Alzheimer's patients, 71.4 percent of whom were women and whose average age was 81.0 years, found no difference in cognitive functioning using the Mini-Mental State Exam, the Severe Impairment Battery, and the Alzheimer's Disease Assessment Battery at 6 and 18 months after adjusting for their baseline cognitive function, age, gender, and using of cholinesterase inhibitors with and without a high anticholinergenic load (Fox, 2011, Abstract). This finding contradicts the finding that the elderly are “particularly sensitive” to the effects of anticholinergic medications because cholinergeric neurons in the brain decrease with age while the elderly are more likely to be taking medications with anticholinergice effects. Between 20 to 50 percent of the elderly in the United States take at least one anticholinergic medication, and earlier studies have implicated cholinergic medications as a cause of delirium (Fox, 2011, para. 1-5).

Results

Study participants took a mean 3.64 number of medications, and their anticholinergic load was 1.1. At baseline, 47 percent of them were taking cholinesterase inhibitors, but after 18 months, 56 percent were taking cholinesterase inhibitors, confirming a correlation between declining cognitive scores and the total of medications these patients were taking. However, the study didn't show any significant causal link between Agitated Behavior Scale scores at cognition at baseline, 6 or 18 months. Furthermore, no link existed between the baseline anticholinergic load and changes in the MMSE and the SIB. The lack of effect on the ABS scores might because advanced cognitive impairment decreases sensitivity or because they any already taken a sufficient amount of anticholinergic medications over such a prolonged time period that this had alread effected their cognitive functioning (Fox, 2011, para. 10-13).

Limitations

The data set only contained drugs prescribed at a single point in time, so researchers weren't able to collect cumulative ABS scores. The research also didn't consider other factors, like institutionalization, diabetes, hypertension, smoking, and alcohol use, that might lower the scores on the MMSB. Furthermore, taking cholinesterase medications may mask the effect of anticholinergic medications (Fox, 2011, para. 15 & 17).

Researchers, however, concluded that taking a single low dose ananticholinergic medication doesn't predict rapid cognitive decline in patients already diagnosed with Alzheimer's over the next 6 to 18 months (Fox, 2011, para. 18).

Gray, S. L., Anderson, M. L., & Dublin, S. et al. Cumulative use of strong anticholinergics and incident dementia: A prospective cohort study. (2015, January 26), JAMA Internal Medicine. doi: 10.1001/jamainternmed.2014.7663.[Abstract only]. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25621434

Researchers associated higher cumulative anticholinergic use with an increased risk for dementia, so they advise physicians of older patients to minimize their anticholinergic medication use over time. From 2004 through September 2012, the Seattle, Washington, study followed 3,34 participants age 65 or older with no initial signs of dementia, using data from the Adult Changes in Thought study in Group Health. “Computerized pharmacy dispensing data” confirmed cumulative anticholinergic exposure. Using standard diagnostic criteria, 797 participants, or 23.2 percent of those studied, developed dementia while 79.9 percent developed Alzheimer disease.

Online Sources Publicize a Link Between Anticholinergic Drugs & Alzheimer's

 

Try turning to natural remedies before 

automatically popping a pill.

Not only should older adults avoid the habitual use and high dosage levels of anticholinergic drugs, but they also shouldn't take any drugs, including all antihistamines, barbiturates, Central Nervous System stimulants, benzdiazepines, muscle relaxants, and tricylic antidepressants that are known to produce adverse cognitive effects in older adults, or at the very least prescribe the lowest effective dosage for a limited period of time only after cataloging all the prescription and over-the-counter mediications the individual has taken in the last decade. Consumers similarly should look for natural cures. like using melatonin as a sleep aid, quercetin as a substitute for antihistamines, and St. John's Wort to treat mild depression after checking with a physician, or when possible turning to behavior modification therapy. For example, sleep problems should first be treated by keeping a regular routine, getting plenty of exercise.

Anticholinergic warning. (2015, February 1). Alzheimer's & Dementia Weekly. Retrieved from http://www.alzheimersweekly.com/2015/02/anticholinergic-warning.html

Alzheimer's & Dementia Weekly provides readers with a synopsis of the latest research detailing a link between taking anticholinergic medications and dementia as well as presenting this information in a video and providing them with a Anticholinergic pocket reference card (Anticholinergic-warning, 2015, February para. 1).

The Seattle University study assessing the “Cumulative Use of Srong Anticholinergic Medications” uses more rigorous research methods, a longer-follow-up period than earlier similar studies have, and it also used pharmaceutical records to confirm the findings of previous studies that had linked a higher risk for dementia with taking anticholinergic drugs. It is also the first study to correlate dementia risk with dosage levels as well as the first research that suggests that cognitive damage caused by taking anticholinergic medication may not be reversible even when individuals stop taking anticholinergic drugs (Anticholinergic warning, 2015, February 1, para. 2).

Because older adults take over-the counter medications with strong anticholinergic effects, the study's head researcher, Shelly Gray urges older adults to share their over-the-counter drug use with their physicians, even though she also cautions that patients shouldn't stop taking any drugs without first consulting a health-care provider. At this point, physicians can find an alternative medication (Anticholinergic warning, 2015, February 1, para. 4).

Alzheimer's Weekly also identified the most common anticholinergic antidepresseants, antihistamines, and antimuscrines as well as SSRIs in the study:

• Tricyclic antidepressants like doxepin (Sinequan)

• First-generation antihistamines like chlorpheniramine (Chlor-Trimeton)

• Second-generation antihistamines like loratadine (Claritin) for allergies.

• Antimuscarines for bladder control like oxybutvnin (Ditropan)

• Selective serotonin re-uptake inhibitors (SSRI) like citalopram (Celexa) or fluoxitene (Prozac) for depression

(Anticholinergic Warning, 2015, February 1, para. 5)

Although medications for urinary incontinence are harded to come by than those for other medical conditions for which anticholinergic drugs are prescribed, behavior modification therapy can help control this problem (Anticholinergic Warning, 2015, February 1, para. 6).

However, if physicians prescribe a anticholinergic drug because it's the “best therapy”, they should prescribe the lowest effective dosage and monitor its use to see if it's effective. Anticholinergic drugs are harmful because they block a neurotransmitter called acetycholine. In addition to causing memory loss, anticholinergic drugs cause drowsiness, constipation, the retention of urine, and dry mouth and eyes (Anticholinergic Warning, 2015, February 1, para. 7).

The Anticholinergic Pocket Reference lists the following types of conditions for which physicans routinely prescribe anticholinergic drugs:

• Allergy cough and cold medicines (antihistamines)

• Anxiety

• Asthma & C.O.P.D.

• Bladder incontinence (antispasmodics)

• Insomnia/sleep disorders

• Motion sickness/ dizziness & nausea

• Movement disorder

• Muscle spasm and pain

• Seizure/mood disorders

• Psychosis (antipsychotics)

• Stomach & G.I. Tract disorders (antispasmodic medicines)

Behavioral symptoms. (2015). Alzheimer's Association. Retrieved from http://www.alz.org/professionals_and_researchers_behavioral_symptoms_pr.asp

Physicians recommend that individuals diagnosed with dementia do not take over-the-counter sleep remedies and antihistamines, such as Benadryl, whose main ingredient is diphenhyramine. Diphenhydramine suppresses a chemical that Alzheimer's also reduces (Behavioral symptoms, 2015, para. 25).

Over-the-counter sleep aids that contain diphenhyramine include Compoz, Nytol, Sominex, and Unisom, while diphenhyramine is also a key ingredient in many night time versions of popular pain relievers and cold and sinus remedies (Behavioral symptoms, 2015, para 26).

Harding, Anne. (2015, January 26). Widely used drugs tied to greater dementia risk for seniors. Live Science. Retrieved from http://www.livescience.com/49581-anticholinergic-drugs-dementia-risk.html

Recently published research confirms that adults aged 65 and older who regular take over-the-counter sleeping pills, antihistamines and over active bladder medications that produce anticholinergic effects also increase their risk of dementia, even though they have long known that even a single dose of drugs that block the acetycholine transmitter reduces one's ability to concentrate, While researchers at the University of Washington School of Pharmacy thought this was reversible if an individual stopped taking antichlinergic medications, they have now determined that dosage and length of time taking these drugs greatly increases the chance of developing dementia (Harding, 2015, para. 1-4).

Up to 37 percent of all senior adults use anticholinergic medications, and while previous research has linked them to “permanent cognitive changes”, this research has failed to take into consideration the fact that physicians often prescribe anticholinergic durgs to treat early warning signs of dementia like depression and insomnia (Harding, 2015, para. 5-6).

Shelly Gray and her fellow researchers analyzed data from the pharmaceutical records of 3,415 senior adult aged 65 and older who were free from dementia at baseline, but over the next seven years, as neurologists diagnosed 797 study participants (or 23.2 percent) with dementia, researchers found that the higher the cumulative dosage of anticholinergic medications was over the ten years before a participant entered the study, the greater his or her risk of developing Alzheimer's (Harding, 2015, January 26, para. 8-9). Thus, taking 10 milligrams of doxepin for three years increased the risk of dementia as did taking 4 milligrams of cholrpehnramine daily or 5 milligrams of oxybutrin daily (Harding, 2015, January 26, para. 11).

To control for the effect of anticholinergic sleep aids and antidepressants prescribed to treat the early signs of dementia, researchers intentionally omitted the pharmaceutical records of participants during the first two years before they were diagnosed with Alzheimer's or other dementia disease (Harding, 2015, January 26, para.10).

Shelly Gray, the head researcher in the University of Washington study warned older adults not to stop taking any of their medication without taking with a health-care provider, but she also asks them to go over the list of all the prescription and over-the-counter medications they have been taking (Harding, 2015, January 26, para 12).

Noll Campbell and Malaz Boulaini, who wrote a commentary that appeared along with the study in the JAMA Internal Medicine argued that it might be possible to reverse adverse cognitive effects of anticholinergic drugs if individuals stop taking them early enough since a stronger association links anticholinergic medications to mild cognitive impairment than dementia (Harding, 2015, January 26, para. 13-14).

Hughes, Sue. (2015, January 27). 'Strongest evidence yet' links anticholinergic drugs, dementia. Medscape Medical News>Neurology. Retrieved from http://www.medscape.com/viewarticle/838788

A University of Washington, Seattle longitudinal study implicates anticholinergic drugs taken by approximately 20 percent of the older adult population, including over-the counter antihistamines and sleep aids as well as medications for an over-active bladder,and anti-depressant, finding “an obvious dose-response relationship between anticholinergic drug use and risk of developing dementia.” (Hughes, 2015, January 27, para. 1-4).

Even Low Doses Implicated

Moreover, individuals taking “just the minimum effect dose” for prolonged period stood a greater risk of developing dementia compared with those who didn't take anticholinergic medications, even though research Shelly Gray emphasized, “This is not excessive use. Many of these agents are used chronically, and chronic use—even at low doses—would put you in the highest risk category (Hughes, 2015, January 27, para. 5-7).

Because anticholinergic drugs have other side effects,such as dry mouth, constipation, and urinary retention, they aren't as popular as they once were, but physicians still commonly prescribe them, and many of these medications can be bought over-the-counter (Hughes, 2015, January 27, para. 8). Even so, the study doesn't prove causality, because researcher is still based on observational data. Thus, Dr. Gray adds, “I would say that we haven't proven these drugs cause dementia, but our results certain reinforce concerns about this issue” (Hughes, 2014, January 27, para. 8-10). While physicians and pharmacists are aware that anticholinergic drugs cause short-term drowsiness and confusion, their long-term effect aren't so well known (Hughes, 2014, January 27, para. 11).

The Seattle study followed 3,434 older adults whose average age was 73 years over a ten-year period, tracking their medications from pharmacy records. Followup examinations added another 7.3 years to study that screen for dementia every two years. About 20 percent of the population used anticholinergic drugs while researchers determined a minimum effective dosage for each drug and then calculative the participants' calculated cumulative exposure (Hughes, 2015, January 27, para. 13-14). During the follow up period, 797 participants (or 23.2 percent) developed dementia,and 79.9 percent of these were diagnosed with Alzheimer's. Taking an anticholinergic medication, such as Benadryl, every day for three years put participants in the highest risk category as did taking the minimum effective dosage sporadically over a longer period or a higher dosage for a shorter period (Hughes, 2015, January 27, para. 15-16).

"Very Credible Data"

Noll L. Campbell, of the Purdue University College of Pharmacy, notes that this study provides “the strongest evidence to date that anticholinergic drugs cause dementia”since the Seattle observational study furnishes the longest record of medication history (Hughes, 2015, January 27, para. 17-18).

Campbell noted that several studies have associated anticholinergic medications with cognitive problems. He also explained that future studies would try to understand the biochemical mechanism that underlies this link since the patients in the Seattle study have granted researchers the permission to autopsy their brains (Hughes,2015, January 27, para. 20 & 22).

However, the next step in research equating the use of anticholinergic drug use with a higher risk dementia could be a randomized study of anticholinergic drug users that upon the researchers' request continue to take them or stop their use (Hughes, 2015, January 27, para. 23).

Medications to be avoided. (2015). Frontotemporal dementia. UCSF University of California San Francisco. Retrieved from http://memory.ucsf.edu/ftd/medical/treatment/avoid/multiple

The Memory and Aging Center at the University of California San Francisco while noting medications that shouldn't be prescribed for frontotemporal lobe patients reminds physicians, pharmacists, and the elderly that many different classes of medications shouldn't be prescribed for long-term use, and when possible all patients should be treated with alternative medications and non-prescription therapies:

• Anticholinergic medications
• Antihistamines
• Barbiturates
• Benzodiazepines
• CNS stimulants
• Muscle relaxants
• Tricylic antidepressants

Anticholinergic medications

Anticholinergics while leveling out the production of dopamine and aceycholine decrease acelylcholine activity, so physicians in the past have routinely prescribed them to treat incontinence, depression, and sleep disorders. However, anticholinergic medications also cause acute cognitive impairment and possible confusion and hallucinations. Additionally, they might “antigonize” any cholinesterase inhibiting medications (USCF, 2015, para. 1).

Nevertheless, the number of anticholinergic drugs prescribed and their dosages as well as the patient's baseline cognitive function and his or her sensitivity to medications also influence the potency of anticholinergic medications (USCF, 2015, para. 2).

Thus, physicians and patients' family members should evaluate an anticholinergic medications as well as its benefits while coming up with alternatives to control a condition; for example, with incontinence, they should determine whether incontinence is functional or urge based and then implement scheduled toileting, check post void residuals, and reduce the anticholinergic medication, discontinuing its use if continence doesn't improve within six weeks (USCF, 2015, para 3-4).

Antihistamines

Antihistamines block histamine, a substance that produces allergic symptoms. Examples of histamines containing cholinergics include diphenhydramine, including the over-the-counter brand names Benadryl and Sominex (USCF, 2015, para. 5).

Barbiturates

Barbiturates help patients relax and sleep, but their continuous use may cause memory loss, decrease alertness, and diminish interpersonal functioning (USCF, 2015, para. 6).

Benzodiazepones

Observational studies link benzodiazepenes with memory loss and confusion as well as falling in elderly patients. When prescribed for FTL disorder patients, they cause amnesia, hostility, irritability, and disquieting dreams, so if prescribed, they should be taken for only a short time. Instead of prescribing benzodiazepones, like Valium, to relieve stress, try “non-pharmacological supportive strategies”, When used to treat sleep problems, try increasing physical activity during the day or taking melatonin, or trazodone (USCF, 2015, para. 7-8).

CNS stimulants

FTD increases sensitivity to medications affecting the central nervous system, like Fluoxetine (Prozac), thus impairing memory and delaying psychomotor performance (USCF, 2015, para. 8-9).

Muscle relaxants

Even though muscle relaxants treat muscle spasms associated with spinal cord injuries, stroke, multiple sclerosis, and cerebral palsy, the use of some muscle relaxants can cause liver damage (USCF, 2015, para. 10).

Tricyclic antidepressants

Instead of prescribing tricyclic antidepressants that may worsen memory problems and “antagonize” the effects of cholinesterase inhibitors, physicians should consider alternative medications that produce the least anticholinergic side effects (USCF, 2015, para. 11-12).

Mertz, Beverly. (2015, January 28). Common anticholinergic drugs like Benadryl linked to increased dementia. Risk. Harvard Health Blog. Retrieved from http://ww"w.health.harvard.edu/blog/common-anticholinergic-drugs-like-benadryl-linked-increased-dementia-risk-201501287667

A study that the JAMA Internal Medicine issued in mid-January “offers compelling evidence of a link between long-term use of anticholinergic medications like Benadryl and dementia” (Mertz, 2015, January 28, para. 2). Anticholinergic drugs block acetylcholine, a chemical substance that carries messages in the nervous system. Acetylcholine transmits messages within the brain necessary for learning and memory while elsewhere in the body it stimulates muscle contractions. Thus, anticholinergic drugs include some antihistamines, tricyclic antidepressants, and drugs that control an overactive bladder or relieve Parkinson's symptoms (Mertz, 2015, January 28, para. 3).

What the study found

Tracking pharmacy records for the ten years before 3,500 older men and women became part of the Adult Changes in Thoughts longitudinal study conducted by the University of Washington and Group Health, a Seattle health care system, a team of researchers at the University of Washington's School of Pharmacy discovered that 800 of these volunteers developed dementia. They also found that those who used anticholinergic medications were more likely to develop dementia than those who didn't take take them. What's more, their risk of developing dementia increased with each cumulative dose—taking an anticholinergic drug for three years increased the changes of developing dementia 54 percent compared with those individuals who took the same dosage for three months or less (Mertz, 2015, January 28, para.4).

Since the production of acetycholine decreases with age, taking anticholinergics “delivers a double whammy” because taking anticholinergic medications interferes with short-term memory and reasoning (Mertz, 2015, January 28, para. 5).

The University of Washington is the first to assess the effects of over-the-counter medications as well as “the possibility that people were taking a tricyclic antidepressant to alleviate early symptoms of undiagnosed dementia” since 'the risk associated with bladder medications was just as high” (Mertz, 2015, January 28, para. 6).

The study should also serve as a reminder to re-evaluate the medications older adults are taking to see if they are working as they should be since many medications have a stronger effect on senior adults since their kidneys and livers don't flush the chemicals from the body as they would if they were younger, and since fat and muscle mass distribution changes with age, the way the body breaks down these medications drugs and apportions them to body tissues differs (Mertz, 2015, January 28, para. 7).

What should you do?

Fortunately, alternatives to anticholinergic medications now exist: Selective serotonin re-uptake inhibitors (SSR) like citalopram (Celexa) or fluoxetine (Prozac) successfully treat depression while antihistamines like loratadinne (Claritin) can take the place or diphenhydramien or cholorpheniramine (Chlor-Trimeton).  Behavioral modification therapy and Botox injections can alleviate incontinence problems (Metz, 2014, January 28, para. 8). However, Mertz urges patients to clear continuing to take all prescription and non-prescription medications with a primary care physician (Metz, 2014, January 28, para. 9).

Roberts, Michelle. (2015, January 27). Dementia 'linked' to common over-the-counter drugs. Health. BBC News. Retrieved from http://www.bbc.com/news/health-30988643

A study published in the JAMA Internal Medicine has linked the prolonged use of three or more years of over-the-counter medications that treat insomnia, hay-fever to dementia in the elderly to medications that block a acetylcholline neurotransmitter However, researchers caution that patients should not stop taking any medications without checking with a primary-care physician (Roberts, 2015, January 27, para. 1-6).

Side-effects

Researchers have linked the prolonged use of anticholinergic medications with an increased chance of developing dementia, so a spokesperson for the United Kingdom's Alzheimer's Society urges physicians and pharmacists “to be aware of this potential link” , although patient information leaflets currently issued with anticholinergic medications already caution consumers that their side effects include reduced attention spans and memory problems (Roberts, 2015, January 27, para 7-9).

Drugs in the study

Researchers are the University of Washington determined that 797 study participants developed dementia upon following 3,434 adults age 65 or older while also tabulating and analyzing their pharmacy records, including medications that had an anticholinergic effect, although study participants only purchased 1/5 of these drugs as over-the-counter medications:

• Tricyclic antidepressants for treating depression

• Antihistamines used to treat hay-fever and allergies

• Antimuscarinics for treating urinary incontinence

(Roberts, 2015, January 27, para. 10-14)

The most common anticholinergic drugs treat depression, sleep deprivation, allergies and hay fever and urinary incontinence (Roberts, 2015, January 27, para. 13).

The most commonly used anticholinergic-type drugs were medicines for treating depression, antihistamines for allergies such as hay-fever or to aid sleep/promote drowsiness, and drugs to treat urinary incontinence.

'Not causal'

Researchers concluded that study participants taking at least 10 milligrams a day of the antidepressant doxepin, four milligrams daily of the sleep aid diphenhydramine, or five milligrams a day of the urinary incontinence medication oxybutynin for more than three years showed a greater risk of developing dementia (Roberts, 2015,January 27, para. 15).

Accordingly, researchers urged physicians and pharmacists to find alternatives to these medications or else if no alternative is possible to issue the lowest effective dosage, although physicians will also have to look at brain pathologies (Roberts, 2015, January 27, para. 16 & 18).

The head of research at Alzheimer's Research UK labeled the study “interesting but not definitive” while the representative of the UK's Alzheimer's Society talked about “concerns” that the prolongued use of anticholinergic medications can increase the risk of dementia under certain circumstances (Roberts, 2015, January 27, para. 19-20).

Like their US counterparts, British authorities cautioned against stopping any medications without talking with a GP (Roberts, 2015, January 27, para. 22).

The UK representative for a trade association that manufactures over-the-counter drugs also warned that non-prescription allergy medications and sleeping aids aren't meant to be taken over a long period of time (Roberts, 2015, January 27, para. 26).

Smith, Natalie. (2013, May 22). Clinical information: The case of Benadryl causing dementia. Clinical Corrections. Retrieved from http://www.clinicalcorrelations.org/?p=6162

A six-year longitudinal study, “Use of anticholinergics and the risk of cognitive impairment in an African American population”, published in the July 2010 issue of Neurology by N. L. Campbell and M. A. Boustani, et al, found that taking anticholinergic drugs possibly raises the risk of dementia slightly after reviewing the cognitive functioning of 1,600 African American over age 70 over a six-year period (Smith, 2013, May 22, para.4). Eleven percent or 179 participants definitely had taken anticholinergic medications, so researchers calculated the ratio for their developing dementia at 1:46. They concluded that data didn't support the hypothesis that taking anticholinergic drugs increases the risk of Alzheimeer's, although the study “suggested” that such a link might exist (Smith,2013, May 22, para. 6).

Steinbuch, Yaron. (2015, January 27). Alzheimer's risk elevated by such-over-the-counter drugs as Benadryl and Nyton: Study. Market Watch. New York Post. Retrieved from http://www.marketwatch.com/story/alzheimers-risk-elevated-by-such-over-the-counter-drugs-as-benadryl-and-nytol-study-2015-01-27

Bottom Line: Using anticholinergic drug increases the odds that an individual might develop dementia, but research at this point in time can't determine if anticholinergic drugs cause dementia (Steinbuch, 2015, January 27, para. 12).

Quoting the middle-class, British tabloid, The Daily Mail, Steinbuch links Nytol, a sleeping pill, and allergy medications, Benadryl and Piriton, along with some antidepressants with a small, increased risk of dementia since these medications contain anticholinergic substances that block acetylcholine, a key chemical messenger within the brain. Moreover, they theorized that the risk of developing dementia increases when individuals take repeated doses of these drugs over several years (Steinbuch, 2015, January 27, para. 2-4). Steinbuch thus cautions that primary care physicians should regularly review their older patients' drug regimes, including any over the counter medications they might be taking. However, these same patients should consult their physicians before they stop taking these medications (Steinbuch, 2015, January 27, para. 5-6).

The study that appeared in the January issue of JAMA Internal Medicine, researchers monitored 3,434 men and women over age 65 for seven years as they used anticholinergic medications. During the course of the study, 637 subjects developed Alzheimer's and 160 patients went on to be diagnosed with another type of dementia. Researchers noted that those who took the highest doses of anticholinergic drugs had a 54 percent greater risk of succumbing to dementia than those who didn't take any anticholinergic drugs while their risk of diagnosed eventually with Alzheimer's was 63 percent higher. Those with the highest risk of developing dementia took at least 10 milligrams a day of the antidepressant doxepin, or 4 milligrams daily of diphenhydramine found in Nytol and Benadryl, and 5 milligrams daily of oxybutyn in the over-active bladder medication Ditropan for at least three years (Steinbuch, 2015,January 27, para.7-10).

Williams, Sean. (2015, February 7). These common medications may put you at a greater risk of developing dementia. The Motley Fool. Retrieved from http://www.fool.com/investing/general/2015/02/07/these-common-medications-may-put-you-at-a-greater.aspx

A fresh study from the Group Health Research Institute published in JAMA Internal Medicine pinpoints some very common nonprescription medications that could increase the risk of dementia (Williams, 2015, February 7, para. 4).

These medications may increase your risk of dementia

From 2004 to 2012, the Group Health Research Institute followed 3, 434 participants starting at age 65 assessed Adult Changes in Thought in a study designed to assess whether anticholinergic drugs building up in the body lead to an increase risk in dementia and found that this indeed might be the case: 797 participants (or 23.2 percent of study participants) went on to the diagnosed with dementia), although the study didn't provide a control group incidence rate for dementia. Additionally, even when the patients stopped taking anticholinergic drugs, researchers could offer no guarantees that their adverse effects were reversible (Williams, 2015, February 7, para. 6-7).

Anticholinergic drugs are those drugs that block the antilcholinergic neurotransmitter in the drug, helping them treat incontinence, asthma, muscular spasms, depression, and sleep disorders. Examples of anticholinergic drugs included over-the-counter medications like Dramaine, Benadryl, and Advil PM as well as prescription medications Wellbutrin, Zyban, and Unisom (Williams, 2015, February 7, para. 8).

Because of this threat to mental health, researchers urge seniors to share their history of taking Over the Counter medications with their primary care physician as well as asking him or her to prescribe alternative medications to these anticholinergic drugs or if necessary prescribe the lowest possible dose (Williams, 2015, February 7, para. 9). However, they also advise consulting a physician before stopping taking these well-known drugs cold-turkey (Williams, 2015, February 7, para.10).

Some study participants have agreed to let researchers autopsy their brains upon death to see if pre-existing pathologies predisposed these patients to develop dementia, or if taking anticholinergic drugs spurred on the development of Alzheimer's or other dementias (Williams, 2015, February 7, para. 11).

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The links furnished on this Web page represent the opinions of their authors, so they complement—not substitute—for a physician’s advice.

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Home Remedies for Allergies

WebMD recommends drinking green tea and eating hot spicy foods like cayenne pepper as well as onions and garlic to clear the sinuses without taking any medications.

http://www.webmd.com/allergies/features/relieve-allergies-natural-way

Home Remedies for Life recommends such cures as taking Vitamin C and eating the fruits and vegetables rich in it, breathing steaming salt water, acupressure, the use of saline spray, and massaging the temples.

http://homeremediesforlife.com/sinus-headache/