August 5, 2014

Are Commonly-Prescribed Anticholinergic Drugs Increasing Your Risk of Cognitive and Physical Decline?

If you take an anticholinergic drug – widely prescribed (and available over the counter, too) to treat conditions like asthma, high blood pressure, insomnia, dizziness and diarrhea – you may be risking cognitive and physical decline… especially if you’re a senior.

These drugs reduce the brain’s production of acetylcholine, a neurotransmitter -- the first ever identified -- that plays a key role in attention, arousal, and muscle function. Typical of so much in healthcare treatments, the drug’s positive effects typically carries negatives, too.

In the case of these anticholinergics, the side effects are scarier than those we often see. In addition to the risk of cognitive and physical decline, the drugs can also cause sedation, confusion, and delirium. See the "Antocholinergic Pocket Guide" below. It lists many of drug with anticholinergic properties, and the ailments / conditions for which physicians prescribe them.

Over 60,000 Cases Reviewed
A team from the UK's University of East Anglia and the Indianapolis-based Regenstrief Institute recently reviewed 46 different studies that followed 60,944 patients who had taken anticholinergic drugs for up to ten years. The results of that extensive study indicate that these drugs could be a cause of cognitive and physical decline in the elderly.

Dr Chris Fox, lead researcher from UEA's Norwich Medical School said, “This is the first research to show a significant decline in physical, as well as cognitive, function. This means patients could become less and less able to carry out everyday activities like walking around, feeding themselves, washing and getting dressed.”

Fox suggested that the drug's blocking effect of the neurotransmitter acetylcholine is clearly the culprit. He also indicated that seniors are more at risk because of increased “blood-brain permeability,” or the ability of the drug to successfully transfer from bloodstream into the neurons.

It seems as if seniors -- as a result -- may get a heartier dose than younger people -- another difference that underscores
All the Usual Caveats
Dr. Fox also announced that more research is necessary to discover which types of anticholinergic drugs present the greatest dangers, especially to seniors. He also issued the standard concern about cause and effect: Did these drugs unequivocally cause the cognitive decline that researchers found, or was the deterioration more a function of the disease the drugs were designed to treat?

These questions are compelling, especially in light of the drugs's widespread use. About half of all elderly people in the United Kingdom receive prescriptions for medications with anticholinergic properties. Other anticholinergics are available over the counter, so the number of users could be significantly greater.

How should healthcare professionals and their patients react to this new study information? Dr. Fox issued this warning:
In the meantime, the prescription of these medications for people with dementia should be cautiously assessed, monitored and attempts made to reduce the burden whenever feasible. Clinicians should conduct regular reviews of the medication taken by their older patients, both prescribed and over the counter, and wherever possible avoid prescribing multiple drugs with anti-cholinergic effects.
The Regenstrief Institute’s Dr. Noll Campbell, co-author of the report, thought it unlikely that the use of these anticholinergics would decline significantly, because patients and their doctors have become so familiar with these drugs, and don’t know about alternatives that could bring relief without exposing patients to the risks.

Non-Anticholinergic Solutions for Sleep Problems
Campbell offered several suggestions. For example, patients taking drugs with anticholinergic properties for sleeping problems could
  • Refrain from daytime napping,
  • Limit exercise at night, and
  • Remove distractions from the bedroom.
(Last fall, I wrote a series of posts about sleep. One of them, "Sleep: How to Do It Better," offers other helpful strategies for getting a better night's sleep.)

Campbell also made this recommendation for hospitals and nursing homes: Keep patients awake and stimulated during the day in order to improve the chances for a proper night’s sleep.

Here’s the “Anticholinergic Reference Card” produced by the Health Effectiveness Research Center at the University at the University of Iowa. It appeared in the August 3, 1014 online edition of Alzheimer's Weekly.

The Anticholinergic Reference Card

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