From: mjs23x@gmail.com   
      
   Are Your Drugs Raising Your Risk for Dementia?   
   Many popular prescription and over-the-counter medicines have anticholinergic   
   activity and can increase the possibility of developing dementia.   
      
   Joe Graedon   
   January 27, 2015   
   Alzheimer’s Disease   
   58 Comments   
   Senior Man, arms crossed, looks down at large assortment of prescription pill   
   bottles   
   Here we go again, with headlines that sound like they could be hype:   
      
   “Hay-fever drugs linked to Alzheimer’s” (Irish Independent)   
      
   “Over-the-counter pills could raise risk of Alzheimer’s: study” (New   
   York Post)   
      
   “Common allergy, depression meds may increase odds of dementia” (CBS NEWS)   
      
   “Dementia ‘linked’ to common over-the-counter drugs” (BBC News Health)   
      
   These headlines are scary. Should you be concerned? In a word, yes!   
      
   Researchers studied participants in the Adult Changes in Thought (ACT) study   
   conducted in the Seattle area (JAMA Internal Medicine, online, Jan. 26, 2015).   
   These were older people enrolled in an integrated health care delivery system   
   called Group Health.    
   Over 3,000 individuals were included in the research, and none had dementia   
   when they entered the study starting in 1994.   
      
   Scientists tracked their drug use and cognitive function over the next two   
   decades. The higher the dose of anticholinergic drugs and the longer such   
   medications were taken, the greater the risk of dementia. In this study the   
   most common anticholinergic    
   drugs were antihistamines found in over-the-counter allergy drugs and   
   nighttime pain relievers, antidepressants that are also prescribed for nerve   
   pain and medications prescribed to treat incontinence or symptoms of   
   overactive bladder. The authors    
   conclude:   
      
      
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   “Higher cumulative anticholinergic use is associated with an increased risk   
   for dementia. Efforts to increase awareness among health care professionals   
   and older adults about this potential medication-related risk are important to   
   minimize    
   anticholinergic use over time.”   
      
   What Are Anticholinergic Medications?   
   We have been writing about this category of drugs for a very long time because   
   of a clearly established link to cognitive impairment. These medicines are   
   known as anticholinergics because they interfere with the ability of a crucial   
   brain chemical called    
   acetylcholine (Ach) to attach to nerve cells. ACh is essential for muscle   
   contraction. Without adequate amounts of this neurotransmitter you could not   
   breathe, blink your eyes or tie your shoelaces. Body movement can only happen   
   when ACh triggers a    
   muscular contraction.   
      
   Acetylcholine is also critical for proper brain function. Without ACh doing   
   its job transmitting messages between brain cells, you would become forgetful   
   and confused.   
      
   Twilight Sleep for “Painless Childbirth”   
   One of the most potent anticholinergic medications, scopolamine, was used for   
   decades with a narcotic like morphine to induce “twilight sleep.” Starting   
   about a century ago, women were given this combo during labor and delivery so   
   they wouldn’t    
   remember the pain or anything else about the experience. The German   
   researchers who developed this approach in the early 20th century said that it   
   produced:   
      
   “clouded consciousness with complete forgetfulness.”   
      
   Modern-Day Anticholinergics   
   Most physicians are offered a few hours of training about anticholinergic   
   drugs (at best). They are taught about belladonna, aka deadly nightshade. (The   
   drugs atropine, hyoscyamine and scopolamine were derived from the plant Atropa   
   belladonna.) Such    
   medications have been used to treat diarrhea and what was once called   
   “spastic colon.” The combination of atropine and diphenoxylate (Lomotil)   
   remains popular for diarrhea.   
      
   Scopolamine (Transderm Scop) is still prescribed for motion sickness, and   
   ophthalmologists and optometrists may use atropine drops to dilate the pupils   
   during an eye exam. Doctors also employ other anticholinergic drugs such as   
   ipratropium (Atrovent) and    
   tiotropium (Spiriva) for asthma. Anticholinergics such as fesoterodine   
   (Toviaz), oxybutynin (Ditropan) and tolteradine (Detrol) are frequently   
   utilized to control the symptoms of overactive bladder.   
      
   Popular Antihistamines & Sleep Aids   
      
   What most modern-day physicians have not learned, however, is that many other   
   drugs also have anticholinergic activity. As mentioned in the ACT study,   
   first-generation antihistamines were linked to dementia. We are talking about   
   drugs like    
   chlorpheniramine and diphenhydramine (DPH).   
      
   You may be surprised where DPH shows up. It is the primary ingredient in many   
   allergy and hay fever meds including the popular brand name Benadryl. But DPH   
   is also found in a huge number of nighttime pain relievers and sleeping pills.   
   Look at the label    
   of Advil PM, Aleve PM, Bayer PM, Excedrin PM, Nytol, Simply Sleep, Sominex,   
   Tylenol PM or Unisom and you will likely find diphenhydramine as a key   
   ingredient.   
      
   We do not worry very much about the occasional use of such drugs. But chronic   
   use, day in and day out for both pain and insomnia, begins to add up to   
   substantial anticholinergic exposure.   
      
      
      
   Antidepressants   
      
   The researchers noted that an older class of antidepressants called   
   “tricyclics” was also linked with dementia. Drugs such as amitriptyline or   
   doxepin are not prescribed as much for depression as they once were. That’s   
   because of newer    
   antidepressants such as citalopram (Celexa), escitalopram (Lexapro),   
   fluoxetine (Prozac) and sertraline (Zoloft). But some physicians prescribe   
   amitriptyline for nerve pain and doxepin for insomnia. These drugs can produce   
   classic anticholinergic side    
   effects: dry mouth, constipation, blurred vision, rapid heart rate, difficult   
   urination, confusion, cognitive impairment and drowsiness.   
      
   Bladder Drugs (Urinary Incontinence)   
      
   In the ACT study the most common anticholinergic drug in the class of meds for   
   overactive bladder was oxybutynin (Ditropan). Other medicines in this category   
   include fesoterodine (Toviaz), and tolterodine (Detrol). By the way, an   
   over-the-counter form of    
   oxybutynin is now available for women under the brand name Oxytrol.   
      
   Here’s the Real Problem   
      
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