As we age, the worry that crops up most commonly concerns cognitive function, especially memory. While other chronic conditions, such as heart disease and diabetes, might be more common, nothing strikes at the
heart of who we are than our ability to think and
We may joke about
“senior moments,” but our fear of Alzheimer’s and other dementia-related conditions is no laughing matter.
According to the National Academy of Medicine, being physically active and avoiding cardiovascular risk factors such as smoking and hypertension are the top two ways to protect our mental faculties as we age. However, the third most important action might come as a surprise: “Manage your medications.”
Most seniors have at least two chronic conditions for which they take medication, and that number increases as we age. The medications prescribed for these conditions often have cognitive side effects that can mimic, or even aggravate, cognitive decline.
Since the standard medical school education offers little geriatrics training, the prescribing doctor may not even be aware of the risk of the prescriptions they are writing for seniors.
As always, let the patient beware. There are four commonly prescribed classes of medications that affect cognitive function. If you or a loved one take any of these drugs, discuss them with your doctor or pharmacist. They may be able to find a less dangerous alternative.
Here are the four most commonly prescribed medications that affect cognitive function:
- Benzodiazepines are most commonly used to treat anxiety, panic disorders, seizures, and insomnia, although they have other uses.
Common benzodiazepines include Ativan, Restoril, Valium, and Xanax. The generic names for these drugs are lorazepam, temazepam, diazepam, and alprazolam, respectively.
Ativan, which is used for insomnia, is particularly known to affect cognition.
If you or a loved one take one of these medications, the worst thing you could do is stop. You need to be weaned off these medications slowly, and under the supervision of a healthcare professional.
- Nonbenzodiazepines, often referred to as z-drugs, are similar in effect to benzodiazepines and are prescribed for the same medical conditions, though they are chemically unrelated to benzodiazepines.
The most common nonbenzodiazepines are the sleep aids Ambien, Lunesta, and Sonata. The generic names for these drugs are zolpidem, zaleplon, and eszopiclone, respectively.
These three medications have been shown to impair both cognitive function and balance, and there is some evidence that links them to the onset of dementia.
- Anticholinergics are versatile drugs, used for a variety of conditions from incontinence to Chronic Obstructive Pulmonary Disorder (COPD) to Parkinson’s. They also include over-the-counter sleep medications, and any sedating form of antihistamine, such as Benadryl. Common over-the-counter pain medications often come in sedating formulations; these usually are indicated by some reference to nighttime, such as Tylenol PM and NyQuil.
However useful and versatile these drugs may be, the American Geriatrics Society warns that they produce strong side effects in seniors, and warns against their use in the older population. These drugs produce a range of side effects, with cognitive side effects that include confusion, memory loss, and generally worsened cognitive function. They have even been linked to increased risk of dementia-related disorders.
Not all anticholinergics are created equal, however. The degree of danger depends on just how “anticholinergic” an individual drug is. The Therapeutic Research Center has published a list that charts low- and high-anticholinergic medications for different conditions. If a senior needs a medication on the list, they are advised to use a low-anticholinergic formulation.
- Antipsychotics are often used for dementia patients who have disruptive behavioral issues such as aggression, anxiety, insomnia, and wandering.
The most commonly used antipsychotics are Abilify, Risperdal, Seroquel, and Zyprexa. The generic names for these drugs are aripiprazole, risperidone, quetiapine, and olanzapine. Haldol (generic name: haloperidol), an older antipsychotic medication, is also prescribed for behavioral disturbances, though not as frequently.
All antipsychotic medications diminish cognitive function. Haldol and Risperdal, in that order, have been shown to increase mortality in dementia patients.
The US Government Accountability Office reports that between 14-33% of dementia patients are prescribed antipsychotics, and restates the recommendations of the US Department of Health and Human Services that nonpharmacological interventions be prioritized for disruptive dementia patients. Caregiver interventions, such as identifying the triggers of behavioral disturbances, may be more difficult to implement, but should be the first line of treatment for these distressing behaviors in dementia patients.
The best way to avoid harmful medications, particularly for people with multiple conditions, is to be in the care of a staff that is trained in geriatrics, and has had years of experience helping seniors retain cognitive function. The highly-trained, experienced staff at Atlantic Coast Healthcare and Rehabilitation Center, in Lakewood, NJ, is dedicated to monitoring medications, seeking out medication interactions, and medication-food interactions. We provide the best possible care for senior cognition, taking a restorative approach to the senior years by offering a variety of activities, physical and social, to keep seniors physically, emotionally, and mentally healthy.
Atlantic Coast prides itself on its caregiver training, and the compassion with which staff treat all patients, particularly our most vulnerable patients, those in the Memory Care Unit.
If you have concerns about the medications you or a loved one receive, contact us at 732-364-7100 or by clicking here.