When people get older, they tend to use more drugs. On average, an older person takes four or five prescription drugs plus two nonprescription (over-the-counter) drugs each day. Most drugs used by older people are taken for years. According to new research, anticholinergic drugs, which are commonly used to treat stomach cramps, ulcers, motion sickness, urinary incontinence, and Parkinson's disease, may cause older people to lose their thinking abilities more quickly than seniors who don't take the medicines.
"What we found is being on these drugs does worsen your cognitive performance," said Dr. Jack Tsao, an associate professor of neurology at Uniformed Services University in Bethesda, Md., who led the study of the effect of the medications on older adults who were, on average, 75. "In the course of a few years, there is a small slippage. It's a minor effect."
The research began after Tsao met a 73-year-old patient. Shortly after starting an incontinence drug, she began hallucinating conversations with dead relatives and having memory problems. Her thinking improved when she stopped the drug for several months.
Nearly 80 percent of the study participants took one or more of a class of
anticholinergic drugs, including drugs for
high blood pressure, asthma,
Parkinson's disease and incontinence drugs such as Detrol and Ditropan.
When the team of Dr. Tsao looked more closely at individual drugs, it found those used for Parkinson's disease and bladder problems impaired memory about three times as much as those not taking anticholinergic medicines.
The incontinence drugs were among the most potent and were the most frequently taken of all the anticholinergics in the study. That's why the researchers believe they are driving the memory problems, Tsao said.
Some experts said the research supports previous observations and is helpful because it measures the size of the effect. While on one hand, Dr. Niall Galloway, an expert urologist and director of the Emory University Continence Center in Atlanta, appreciated the study for its being including relatively large numbers, on the other he went on to say that it is not a strong study.
One major problem, he pointed out is that the volunteers are ‘lumped together’, regardless of what the indication is for taking an anticholinergic. It would be helpful to know more specific information, such as how many anticholinergics each patient was taking and how those taking one compared to those taking more than one.
Tsao however took it positive and agreed that more specific information would be better, but, he expressed, “my recommendation is, if someone is having what they feel is a noticeable problem with their ability to remember things, they need to visit their doctor. And they need to mention if they are on one of these drugs."
Galloway agreed, saying that many patients may stay on medications longer than they need to, either because they forget to ask the doctor about it or the doctor doesn't re-evaluate. It's a fair question, he said, to ask your doctor if you need to continue a medication.
More research is needed on the effects of anticholinergic drugs on memory, Tsao said. Doctors should do baseline cognitive testing on patients before prescribing the drugs, he recommended.
