While most people have used over the counter sleep aids or cold medications, some caution might be advisable for certain patients. Research from the Indiana University School of Medicine has shown that some of these medications can have consequences involving cognition, brain atrophy and metabolism. The elderly specifically are at risk from medications that have an anticholinergic effect.
The anticholinergic effect simply means that the medications, commonly called AC drugs, block the neurotransmitter acetylcholine. The brand names of the drugs studied include the over the counter medications Benadryl, Demerol, Dimetapp, Dramamine, Unisom and the prescription only drugs Paxil and VESIcare. A full list of AC drugs can be found in a link at the bottom of this page.
In the Indiana University study 451 participants, 60 of whom were taking at least one medication with medium or high anticholinergic activity were evaluated with cognitive tests, MRIs measuring brain size and PET scans that looked at brain metabolism. The participants were drawn from the Alzheimer's Disease Neuroimaging Initiative, a national Alzheimer’s study, and the Indiana Memory and Aging Study.
Those in the study who were using at least one drug with an AC effect showed lower metabolism and reduced brain sizes. This study was not the first to link the use of these medications to cognitive decline. Earlier research from a collaboration between the IU Center for Aging Research and the Regenstrief Institute found that drugs with a strong anticholinergic effect caused cognitive problems when taken continuously for just the short duration of 60 days. Other drugs with an AC effect, but weaker, could still cause problems taken for a duration of slightly longer at 90 days.
In addition, research in early 2015 from the University of Washington/Group Health Study showed similar problems with AC medications and dementia risk. Lead author of that study, UW Professor Shelley Gray used more rigorous methods, longer follow-up (more than seven years), and better assessment of medication use via pharmacy records (including substantial nonprescription use) to confirm the results which suggested the effects of diminished cognition could remain even after the drugs were discontinued.
While research has focused on these medications and cognition before, the new study, which was published in the journal JAMA Neurology, is the first to point at the possibly biological causes by providing brain measurements and metabolism data.
Shannon Risacher, Ph.D., assistant professor of radiology and imaging sciences and first author of the most recent paper, "Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults” said, "These findings provide us with a much better understanding of how this class of drugs may act upon the brain in ways that might raise the risk of cognitive impairment and dementia. Given all the research evidence, physicians might want to consider alternatives to anticholinergic medications if available when working with their older patients.”
A list of the medications with AC effects tht could be problematic for some patients can be found below the video which also provides more information on the study and what to look for in medications you might use frequently.
University of Washington School of Pharmacy