Older Adults Need to Watch Out For Anticholinergic Agents
Acetylcholine is an important neurotransmitter found in the brain. In fact, reduced amounts of this neurotransmitter have been found to exist in the brain of those that suffer from Alzheimer's disease. Acetylcholine is an important neurotransmitter that plays a significant role in memory, as well as innervation of muscle activity. Anticholinergic agents counter the effects of acetylcholine and block this important neurotransmitter. As was mentioned this can potentially cause adverse effects on memory since it is an important agent for memory.
Older adults can be especially sensitive to medications that fall into the anticholinergic classification. Furthermore, many medications, both prescription and over-the-counter, have anticholinergic potential, leading to potentially harmful effects on the elderly. It has been found that older adults using medications that have anticholinergic features for just two months are at an increased risk for mild cognitive impairment.
However, it appears that not only is the length of anticholinergic medication use important, but also the strength of the anticholinergic agent. Malaz Boustani, MD, associate director, Indiana University Center for Aging Research, studying the issue of anticholinergic agents found that the risk for cognitive impairment increased by 50 percent in adults receiving at least 3 mild anticholinergic agents for more than 90 days and by 100 percent for those receiving one or more stronger anticholinergic agents for 60 or more days.
Common over-the-counter agents such as Benadryl, Sominex, Advil PM, Dramamine and many cold and cough suppressant agents that have dextromethrophan have anticholinergic properties. Many of these agents are taken quite regularly by many older adults for colds, sleep, and allergies, often unbeknownst to their physicians. However, physicians as well have been guilty of over-prescribing anticholinergic medications to older adults. Dr. Boustani states that physicians "absolutely" have been guilty of over-prescribing these forms of medications and often write these prescriptions out with ease and haste instead of sitting down and discussing possible alternatives with their patients.
Many commonly prescribed medications that are frequently used among many older adults have considerable anticholinergic effects. For instance, many drugs used for urinary or bladder issues, such as Oxybutynin, have considerable levels of anticholinergic potential. Furthermore, many medications for treating various forms of mental illness such as antipsychotic and antidepressant medications can have varying levels of anticholinergic potential. Even many agents used to treat Parkinson's disease, heart dysrhythmia, and vomiting just to name a few have anticholinergic properties that can adversely affect the cognitive level of many older adults.
It should be mentioned that the use of anticholinergic medications, although having the potential to lead to mild cognitive impairment, does not subsequently lead the older adult to the more debilitating state of dementia. As Dr. Boustani states, "We found that these medications are a risk factor for the development of MCI, but they are not risk factors for developing dementia." Furthermore, mild cognitive impairment caused by anticholinergic agents is a reversible condition.
Other studies have also found considerable issues with anticholinergic medications and the elderly. In fact, it was found that 23 percent of the medications used within a Medicare managed care population were potentially inappropriate. In fact, antidepressant and anti-anxiety medications were the most commonly cited medications, and it was found that the anticholinergic potential that many of these medications have is often overlooked by many physicians prescribing these medications for the elderly.
The pervasive anticholinergic impact found among many medications, the potential they can have for cognitive impairment, and the heightened sensitivity that many older adults have for these types of medications makes it very important for physicians to be especially mindful of prescribing these medications if alternative or optional modalities are available. Furthermore, older adults need to be more careful in the types of medications they use on an over-the-counter basis. In addition, using the expertise of the pharmacist and requesting their advice on medications that older adults may purchase which may have an adverse anticholinergic impact, many also help to forestall future cognitive impairment related to cursory medication usage. Physicians and older adults have to work together to ward off potentially negative effects of many medications that may ultimately have an ill-effect upon the cognitive health of many of our nation's older adults.
Anderson P. Just Two Months Exposure to Anticholinergics Affects Cognition. Medscape News, May 22, 2013: http://www.medscape.com/viewarticle/804558?src=wnl_edit_medn_wir&spon=34
Robinson DS. Anticholinergic Effects of Drugs and Cognition in the Elderly. Primary Psychiatry 2009;16(5):19-21.
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