The latest statistics show that 10.7% or 6.5 million Americans (65 and over) are living with Alzheimer’s disease in 2022. That is about 1 in 9 people, and it is expected to double by 2050. Every 65 seconds, one person in the US is diagnosed with Alzheimer’s disease and almost two-thirds of them are women. The reasons for this are too complex for this one newsletter, but I want to address one cause – Medications. There are three classifications of drugs that can have this effect on our brains.
1. Anti-cholinergic medications 2. Benzodiazepines and 3. Opioids.
Acetylcholine
Before discussing anti-cholinergic medications, understanding what acetylcholine is helpful. It is a neurotransmitter, which means it is a chemical that nerve cells use to communicate within the brain and in the rest of the body. It is important for memory and for the parasympathetic nervous system. The Autonomic Nervous System is made up of two parts the sympathetic nervous system which has an excitatory effect on us, and the parasympathetic nervous system which has a relaxing effect on us. The parasympathetic is referred to as the “rest and digest” part of the nervous system. The parasympathetic nervous system by way of acetylcholine release is going to help with digestion, saliva production, and tear production for the eyes. Therefore, taking a medication that interferes with acetylcholine could result in constipation, dry mouth, and dry eyes. Those medications will also decrease brain function and make you feel sleepy. The following are medications that should be a red flag if you are taking them on a regular basis, especially if you are a senior citizen.
The Seven Types of Anti-Cholinergic Medications
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Sedating Antihistamines.
Benadryl (Diphenhydramine)
Claritin (Loratadine) This is less anti-cholinergic and is less sedating.
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PM versions of over-the-counter painkillers
Tylenol PM, Nyquil, and Advil PM
The PM effect comes from mixing in a mild sedative, usually a sedating antihistamine. Over-the-counter sleep aids such as Unisom contain the same sedating antihistamine.
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Medications for an overactive bladder (Underlined are the brand names)
Oxybutynin-Ditropan, Tolterodine-Detrol, Solifenacin-Vesicare
When urinating, the parasympathetic nervous system is activated to relax the bladder. As we age, we may get the desire to urinate even when our bladder is not full. By blocking it with these anti-cholinergic drugs you can stop urinary incontinence.
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Medications for vertigo, motion sickness, and nausea
Meclizine (Antivert) This is for benign postural vertigo.
Dimenhydrinate (Dramamine) This is for motion sickness.
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Medication for itching
Diphenhydramine (Benadryl)
Hydroxyzine (Vistaril)
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Medication for nerve pain
Tricyclic antidepressants were an older class of antidepressant medications before SSRI’s (selective serotonin reuptake inhibitors) came around. Now they are used more for nerve pain and with shingles outbreaks, specifically post-herpetic neuralgia.
Amitriptyline (Elavil) and Nortriptyline (Pamelor)
*There is one SSRI that has anti-cholinergic properties and that is Paroxetine (Paxil). If memory concerns are an issue for someone, they should be switched to a different SSRI than Paxil.
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Muscle Relaxers
Cyclobenzaprine (Flexeril)
If someone has pain and memory issues this is a medication that can inhibit acetylcholine and a different pain medication should be prescribed.
Benzodiazepines
These are medications that are used for sleep and anxiety and have been linked to memory loss with long-term usage.
Ativan - Lorazepam
Valium - Diazepam
Restoril - Temazepam
Xanax - Alprazolam
Klonopin – Clonazepam
Triazolam – Halcion
Non-Benzodiazepines Sleep Aids
Sometimes called the Z Drugs, they treat insomnia and mild anxiety.
Eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien).
Anti-Seizure Medications
Why they are prescribed: Long used to treat seizures, these medications can also be prescribed for nerve pain, bipolar disorder, mood disorders, and mania.
Examples: Acetazolamide (Diamox), carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), pregabalin (Lyrica), rufinamide (Banzel), topiramate (Topamax), valproic acid (Depakote) and zonisamide (Zonegran).
How they can affect memory: According to Dr. D.P. Devanand, professor of Psychology and Neurology at Columbia University Medical School, anticonvulsants are believed to limit seizures by dampening the flow of signals within the central nervous system (CNS). Drugs that depress signaling in the CNS can cause memory loss. One thing to note: These medications can be sedating, “and sometimes it’s hard to separate what is a true cognitive decline from simple sedation,” Devanand says.
Alternatives: Many patients with seizures do well on phenytoin (Dilantin), which, at lower doses, has less of an impact on memory. Patients with chronic nerve pain find that venlafaxine (Effexor) — which also spares memory — alleviates their pain. Another option: Ask your doctor if adjusting your dosage is a possibility. Symptoms of cognitive decline are less likely to occur with low doses of antiseizure medicines.
Final Thoughts
These common drugs are pervasively prescribed in America and could be contributing to the increased incidence of memory loss, dementia, and Alzheimer’s disease. Drugs like sedating antihistamines, nerve pain medications, muscle relaxers, sleep, and anxiety medications could be reduced or replaced with natural compounds to address core deficiencies and therapies to address core neurological and behavioral imbalances. To dive into all that would require a book but over time hopefully, I will devote time to some of them. Last month’s newsletter on the histamine connection and how it affects mast cells was one. A previous newsletter on melatonin for sleep was another. This month I wanted to make people aware of how the medications listed above could affect you or a loved one and motivate someone to take steps to prevent future memory loss.
Special thanks to Leslie Kernisan M.D. MPH for her research on this topic.
