Jul
20
2019

Common Drugs Have A Connection To Dementia Risk

A recent publication stated that common drugs have a connection to dementia risk. The study had an observation time of 12 years (from 2004 to 2016) and involved 284,343 patients in the United Kingdom. There is a group of drugs, namely anticholinergic drugs, that were particularly strong with regard to causing side effects of dementia. A variety of anticholinergic drugs exist, such as antidepressants like paroxetine or amitriptyline. But there are other anticholinergic drugs like bladder antispasmodics (they also go by the name bladder antimuscarinics, such as oxybutynin or tolterodine). Other anticholinergic medications are antipsychotics that are in use for psychotic diseases. Examples are chlorpromazine or olanzapine. Anti-epileptic drugs also belong into the anticholinergic drug group. Common anti-epileptic drugs are oxcarbazepine or carbamazepine.

The researchers found that 58,769 of the patients that took strong long-term anticholinergic medication developed a dementia diagnosis.

More about the study

The researchers found that the risk of developing dementia for those who consumed only a few anticholinergic drugs was low. It amounted to only 6%. In contrast, patients who took a lot of anticholinergic drugs at least for 3 years or more developed dementia in 49% of all cases, which is quite a significant amount.

Dr. Douglas Scharre, director of the division of cognitive neurology at the Ohio State University Wexner Medical Center in Columbus was not involved in the study. He said: ”I spend a lot of my time in the memory disorder clinic seeing geriatric patients and taking people off medications, mostly those medications that have anticholinergic properties. Many times there can be another drug out there that has less anticholinergic impact or is non-anticholinergic that may work.”

Risk-benefit discussion

He went on to say that some drugs are really necessary to control a psychosis or seizures, so it is a matter of discussing with the physician whether it is worth taking a risk of possible dementia versus a risk of a flare-up of psychosis or of a seizure.

More statistics

Patients who received treatment for depression with anticholinergic antidepressants had a risk of 29% of developing dementia. Anticholinergic anti-Parkinson drugs had an association of a rate of 52% of dementia. Anti-psychotic drugs led to dementia in 70% of the treated cases. Bladder relaxing medications (medically called antimuscarinic drugs) had a risk of 65% to cause dementia. Finally, anti-epileptic drugs had a risk of causing dementia in 39%.

The researchers noted that these findings highlight how important it is reducing exposure to anticholinergic drugs in middle-aged and older people.

Serious side effects from other medication

Unfortunately there is a history of serious side effects regarding several medications.

Tardive dyskinesia with antipsychotics

Long-term treatment of schizophrenia with antipsychotic drugs can cause severe side effects. One of the more severe side effects is tardive dyskinesia, which occurs in 5% per year of antipsychotic medication use, and in about 1%-2% of these it is severely disfiguring the face. Tardive dyskinesia can lead to permanent involuntary movements of the muscles around the mouth and the eyes. The jaw and the tongue may also show involuntary movements, and in time this leads to a disfigured look of the face, often with asymmetries between the right and left side of the face. Unfortunately, withdrawal of the antipsychotic medications will not improve the tardive dyskinesia. Often expensive lifelong Botox injection therapy every 6 to 8 weeks is necessary to alleviate some of the effects of this devastating dyskinesia.

Side effects from antacid pills

Lansoprazole (Prevacid) belongs to the proton pump inhibitors and is a very strong acid production inhibitor. Because it is so reliable in suppressing stomach acid, it is popular with the public. What is not so well known are the side effects of this drug. The most common side effects are about bone fractures, severe diarrhea, kidney damage, systemic lupus erythematosus and fundic gland polyps. These polyps can later turn into stomach cancer. Unfortunately, drug companies do not always report about the less frequent side effects.

A rare side effect: muscle tremor

One of these side effects is a muscle tremor (jerking movements or shaking). It is listed under the side effects way down the list where you may overlook this. To the patient it can be devastating as the symptoms are very similar to Parkinson’s disease. Imagine a 40-year old man taking this medicine for stomach acid and coming down with these muscle tremor symptoms! Fortunately, when you recognize the connection, you can stop the medication and the symptoms frequently go away or at least diminish.

Rhabdomyolysis from statins

When a patient is receiving statins because of high cholesterol, one of the possible side effects can be rhabdomyolysis. This typically presents with muscle weakness, fatigue, and lower urine output. The urine may be of a dark color. Confusion, vomiting and agitation can also set in. It is necessary to immediately recognize these type of side effects, and the statin drugs should be stopped. The patient requires a kidney specialist to watch the kidney function. Often these patients need treatment in hospital. 

Cancer and heart attacks from synthetic hormones

The “Women’s Health Initiative” with a study on 16,000 postmenopausal women had to be stopped prematurely in 2002. This was a study that examined the effects of two synthetic hormones, the estrogen Premarin and the progesterone-like substance Provera. The purpose of the study was to show whether heart attacks, osteoporosis and strokes would be reduced on hormone replacement compared to controls. But the results were shocking: the opposite was true! The risk in the treatment group for strokes was 41% higher than for the controls and for heart attacks it was 29% higher! But this was not all. The treatment group had twice as many blood clots in their legs and 26% more breast cancer. Colorectal cancer was 37% higher and Alzheimer was a whopping 76% higher than in the controls.

Synthetic hormones caused estrogen dominance

The synthetic hormones functioned like xenoestrogens, meaning that there was a partial resemblance of the synthetic hormones to estrogen and progesterone, blocking their hormone receptors, but not stimulating them. The end result was an estrogen dominance state in the blood, which caused all of the problems. When bioidentical hormone replacement is done with bioidentical estrogen and progesterone, the opposite is the case. Women live longer because they get less heart attacks and strokes; they also get less cancer. In Europe bioidentical hormone replacement has been in use for over 50 years, and in the US physicians who use bioidentical hormone replacement have experience for almost 30 years.

Discussion

We started this article describing side effects of anticholinergic drugs and how this can bring on dementia. Other researchers have noted that dementia and strokes can be brought on by diet drinks. We then got into side effects of other drugs like tardive dyskinesia with antipsychotic drugs. We discussed the possibility of tremors from antacid drugs. A rare side effect of statins is rhabdomyolysis. And we talked about cancer and heart attacks from synthetic hormones in postmenopausal women. We need to be aware that any chemical brought into our system can cause undesirable side effects. Chemicals like drugs can interfere with biochemical reactions in the body that ultimately result in side effects including cancer and heart attacks.

Common Drugs Have A Connection To Dementia Risk

Common Drugs Have A Connection To Dementia Risk

Conclusion

In a recent publication we learnt that patients who took a lot of anticholinergic drugs at least for 3 years or more developed dementia in 49% of all cases, which is quite a significant amount. But there are other drugs that have serious side effects. For instance, there is tardive dyskinesia, a disfiguring condition in the face that can develop with antipsychotic medicine for schizophrenia. Statins can cause a painful muscle condition, rhabdomyolysis. The “Women’s Health Initiative” showed a study that examined the effects of two synthetic hormones, the estrogen Premarin and the progesterone-like substance Provera.

Synthetic hormones causing problems

The purpose of the study was to show whether heart attacks, osteoporosis and strokes would be less on hormone replacement compared to controls. Unfortunately quite the opposite happened. The risk in the treatment group for strokes was 41% higher than for the controls and for heart attacks it was 29% higher! But this was not all. The treatment group had twice as many blood clots in their legs and 26% more breast cancer. Colorectal cancer was 37% higher and Alzheimer was a whopping 76% higher than in the controls. Only bioidentical hormones are tolerated without any side effects. We need to treat our bodies with respect and stay away from noxious substances.

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Jun
11
2016

Drugs Can Cause Dementia

An April 2016 study from Indiana University found that drugs can cause dementia. There were 451 people enrolled in the study with an average age of 73. 60 of them were taking at least one or more anticholinergic drugs. Anticholinergic drugs are drugs that inhibit the neurotransmitter acetylcholine in nerves or in the brain. As a result spasms in the stomach, bowel or bladder are relieved. Also the many over-the-counter sleep medications that may contain anticholinergic drugs help you to fall asleep easier. In the above-mentioned study researchers measured the effects that the drugs have, using different tests. They used memory and cognitive tests to check for memory loss, reasoning and judgment. PET scans are a useful diagnostic tool to measure brain metabolism. MRI scans were used to look for structural brain changes.

Results on how anticholinergic drugs can cause dementia

Memory tests and cognitive function tests showed that those taking anticholinergic drugs did worse on memory tests, verbal reasoning, problem solving and planning. The PET scan showed that glucose utilization by the brain was down in those who were taking anticholinergic drugs. It was apparent that the hippocampus had particularly lower glucose utilization. This is the center where short-term memory takes place. The hippocampus is also the area where Alzheimer’s patients have problems with early memory loss.

MRI scans showed that there were structural brain changes in the patients that were using anticholinergic drugs. There was a reduction of their brain volume (brain atrophy) and there was an enlargement of their brain cavities (ventricles). Overall this meant that their brains had much less brain cells when compared to controls that did not take anticholinergic drugs.

Indian University study about anticholinergic drugs

In a 2013 study from the Indiana University researchers had established that it took only 60 days of taking anticholinergic drugs to cause cognitive problems. Using drugs with only weak anticholinergic side effects, it took up to 90 days before the same cognitive deterioration could be measured.

The researchers concluded that it would be wise for physicians to consider switching a patient to medication that does not include anticholinergic side effects to prevent development of dementia or Alzheimer’s disease.

Anticholinergic drugs can cause dementia

In the study above it was stated that it was the group of anticholinergic drugs that was particularly problematic. These are over-the-counter-drugs like sleep aids, antihistamines, and incontinence drugs etc. that had anticholinergic side effects. The more of these types of drugs people take, the more interactions are possible, leading to full-blown anticholinergic symptoms. As people age, they collect more and more symptoms and diseases. Physicians tend to treat the symptoms with various medications, so it is not unusual for an elderly person to be on 5 or 6 different drugs. If one or more of these drugs have anticholinergic side effects, this can add up and cause the kind of observations the above mentioned clinical study showed: dementia symptoms and proof that the brain metabolism has been slowed down. The brain also experiences the structural changes of dementia that I mentioned.

Possibility that herbs and drugs can cause dementia

The problem does not stop here. It is possible that over-the-counter herbs that you may innocently get in the health food store can participate in the overall metabolic interaction of anticholinergic substances. Many herbs have pharmacological substances in them that have specific helpful effects. But whenever a drug or herb has a positive effect, quite often there is an undesirable effect or side effect.

Historically Belladonna is a poisonous plant that has medicinal values. Unfortunately many Belladonna preparations are available in health food stores that are not regulated by the FDA. Belladonna has strong anticholinergic side effects that interfere with other anticholinergic side effects.

There are many other herbs that are available without prescription.

Kava-kava, passionflower and hops

Kava-kava is an herb and a hallucinogenic that has anticholinergic properties. If you use Kava-Kava, keep in mind that the more you consume it, the more your brain shuts down. Why? The anticholinergic effect of Kava-Kava shuts down acetylcholine, the main stimulus in your brain cells to help you think.

Passionflower is an herb that sedates and is often used as a tincture to help you to fall asleep. What people perceive as a “natural effect” is merely the anticholinergic effect on the central nervous system.

Hops is the calming compound found in beer. It is also often in use together with other sedating herbal sleeping remedies in sleep inducing teas.

St. John’s wort and skullcap

St. John’s wort is also on the list. In smaller doses this herbal antidepressant may be useful and may have less side effects than commercial antidepressants. But there are possible side effects of dry mouth and constipation, which are the result of the anticholinergic side effect.

Skullcap is often used in tea to help a person to fall asleep. But keep in mind that the effect of helping you fall asleep comes from the anticholinergic effect of skullcap on brain cells.

All of these herbs are not any different from the medications in the discussion above, except that they are a bit weaker with regard to the anticholinergic effect.

Street drugs can cause dementia

Many street drugs are sedating and they have anticholinergic effects. It is therefore no surprise that with chronic use of street drugs drug users can come down with dementia, even at a relatively young age. Long-term use of anticholinergic drugs is associated with delirium and dementia.

Particularly benzodiazepines, meperidine (an opioid), antidepressants and many other drugs when taken together cause dementia, in part because of additive anticholinergic activity.

Pathology findings in street drug users

In an Edinburgh study from England 34 deceased patients, who were heavily using street drugs were autopsied. The researchers compared their brains to healthy 16-year-old non-drug users. There was nerve cell damage in the brain area, which is the control center for learning, memory and wellbeing. The pathologist found the same dementia findings that would be present in much older Alzheimer patients. We have to conclude from this that the anticholinergic effect of the drugs they received as a mix in the years prior to their deaths caused the damage to their brain. Toxicity to nerve cells from interacting drugs and their side effects can add up.

Drugs Can Cause Dementia

Drugs Can Cause Dementia

Conclusion

Whenever you have a substance that helps to get you drowsy so you can sleep better, be careful and check that it is not because of the anticholinergic effect of an herb or an over-the-counter drug. Melatonin is an exception, because this is your body’s own sleeping hormone that your body knows. Whenever anticholinergic drugs or herbs act on your brain they can over time cause an irreversible brain atrophy. As mentioned in the study above, an MRI scan can shown brain atrophy quite well. This leads to cognitive problems including memory problems.

PET scan shows slowdown of glucose metabolism in hippocampus

PET scans have also shown a permanent slowdown of glucose metabolism of the brain cells of the hippocampus, where short-term memory is located. Without that function you get permanent dementia. Ask your physician to treat the cause of your symptoms instead of treating you symptomatically. You may not always get the answer you need from conventional medicine. As the next step you may want a second opinion from a naturopath to see whether there would be an alternative treatment available that does not involve anticholinergic medications. Go to the root of the problem, avoid drugs that cause damage, and keep your brain healthy and your mental capacities without cognitive deficits!

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