With June being Alzheimer’s and Brain Awareness Month, it's a good opportunity to discuss medications that might impact cognitive health, especially in seniors. Many of my senior patients are unaware that their medications could be causing some of their symptoms. During my acupuncture sessions, I talk with patients about their lifestyle choices, including diet, nutritional supplements, and medications.
What are anticholinergic drugs?
Medications can be beneficial and even life savers for various conditions, but some, known as anticholinergic drugs, may have side effects that warrant attention. Common anticholinergics include Benadryl (allergies/sleep), Hydroxyzine (anxiety), Benztropine (movement disorders), and Diphenhydramine (antihistamine/sedative). Anticholinergics treat mostly chronic diseases and nervous system disorders such as COPD, overactive bladder, asthma, tremors, gastrointestinal symptoms, allergies and even depression.
How do anticholinergic drugs work?
Anticholinergic drugs work by blocking acetylcholine, a neurotransmitter involved in memory and muscle control. While effective for various conditions, long-term use of these drugs may affect cognitive function and balance. Research suggests they can increase the risk of falls and may be linked to the development of dementia, particularly in older adults who are more sensitive to the effects of medication.
What does the research say?
Studies have explored the relationship between anticholinergic drug use and cognitive health. For example, a study in JAMA Internal Medicine* found that long-term use of these drugs significantly increases dementia risk, which escalates with higher cumulative doses. A Harvard Health blog also reported a 54% higher risk of dementia with anticholinergic use for three years or more.
How to mitigate side effects?
Understanding these potential side effects is important for seniors and their caregivers. Discussing medication options with primary care physicians can help with exploring alternatives. The Anticholinergic Burden Calculator (www.ACBCALC.com) is a useful tool for evaluating and managing the cognitive impact of anticholinergic drugs.
What are alternative options?
Regular acupuncture treatments can be effective in significantly improving cognitive function as well as muscle strength. This was the conclusion of a meta-analysis of randomized controlled trials* that looked at 66 different studies with over 4,191 participants. Other natural alternatives include Chinese Herbs and nutritional supplements, which can offer safe and effective treatment options without the cognitive risks.
Please do not start or stop taking any medications without consulting your doctor.
*References:
- Coupland CAC, Hill T, Dening T, et al. Anticholinergic drug exposure and the risk of dementia: a nested case-control study. JAMA Intern Med, 2019;179(8):1084-1093.
- Gray S L, Hanlon J T. Anticholinergic drugs and dementia in older adults BMJ, 2018;361:k1722.
- Common anticholinergic drugs like Benadryl linked to increased dementia risk. Harvard Health,3. Jan. 19, 2022.
- Lin C-J, Yeh M-L, Wu S-F, Chung Y-C, Lee JC-H. Acupuncture-related treatments improve cognitive and physical functions in Alzheimer’s disease: A systematic review and meta-analysis of randomized controlled trials. Clinical Rehabilitation. 2022;36(5):609-635. doi:10.1177/02692155221079117