SENIOR SPOTLIGHT: Medication and memory loss

Many people are unaware that dozens of painkillers, antihistamines and psychiatric medications, from drugstore staples to popular antidepressants, can adversely affect brain function, mostly in the elderly. Regular use of multiple medications that have this effect has been linked to cognitive impairment and memory loss.

The drugs block the action of the chemical messenger in the brain, which is responsible for a range of functions in the body including memory production and cognitive function. The difficulty for patients is the cumulative affect. Doctors are not always aware of all of the medications their patients take. It's a particular problem for older patients, who are more vulnerable to the effects of these drugs and tend to take more medicines overall.

Now a spate of new research studies has focused on these types of medicines (called anticholinergic drugs). Researchers found that those taking more than one scored lower on tests of cognitive function than those who were not using any such drugs, and that the death rate for the heavy users during the course of the study was 68% higher. "These are very, very common drugs; that's a scary finding," one of the lead researchers from the study noted. The researchers go on to say that they suspect anticholinergics take a toll on bodily organs and systems like the cardiovascular system, although there are no studies confirming this.

The same types of drugs have also been implicated in the delirium that intensive-care patients frequently develop in the hospital. "Clinicians don't think of them nearly as often as they should as a potential cause of cognitive problems," said another professor who studied the deficits that occur after intensive care hospitalization.

Of Americans 65 and older, at least 20% take at least one medication that affects the chemical messengers in the brain. A study of nearly 4,000 older adults found that those who had been using three or more such drugs consistently for 90 days or longer were nearly three times as likely to receive a diagnosis of mild cognitive impairment as those who had not taken any.

"If you were taking one of the drugs we know is definitely an anticholinergic for 60 days, you doubled the odds of developing mild cognitive impairment" compared with a patient taking none, the researchers said.

The aim of studies like these is to evaluate the magnitude of the effects of different drugs, determine whether there are safe thresholds for their use and learn whether the effect is transient and reversible. Studies from large clinics that treat people with memory disorders have shown that up to 25% of the patients who seek help have reversible disorders, including those caused by taking a combination of medications.

Even so, why do physicians prescribe medications that alter chemical messengers in the brain to elderly people, who may be using them regularly for many years? Not only are doctors often unaware of all the medicines their patients are taking, but the list of drugs is a long one.

So what's a patient to do? If you or an elderly relative take one or more drugs on a regular basis, ask your primary care physician to evaluate the cumulative anticholinergic burden of all them (as well as other potential interactions and side effects).

The patient is critical in triggering that kind of discussion. It may not be automatic, but if in fact the patient asks for it, it's much more likely to be done. Remember to tell your physician about drugs prescribed by other specialists, as well as nonprescription or alternative medicines you take. This review should be done once a year. Do not stop medications on your own without medical supervision.

Maureen A. Wendt is president and CEO of The Dale Association, a non-profit organization that provides senior, mental health, in-home care, caregiver support services and enrichment activities for adults. For more information, call 433-1937 or visit www.daleassociation.com .