Anticholinergics and benzodiazepines are both classes of drugs that impact cognitive function. Research into the long-term use of both medications and an increased risk of dementia is ongoing. Can you imagine the concern, confusion, and frustration you might feel when the medicines meant to protect and preserve your loved one’s health potentially threaten their cognition? With this in mind, we’ll examine a list of drugs linked to dementia and provide you with actionable guidance for safeguarding the health of your loved one.
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Despite a lack of clear causation, it’s observed that memory loss is a side effect of the following types of drugs. Because of this, the American Geriatrics Society and numerous studies advise against prescribing these medications to seniors whenever possible:[01]
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Anticholinergics are a class of medications that block the activity of a vital neurotransmitter called acetylcholine.[02] These drugs are associated with significant increases in dementia risk. This list includes certain antidepressants, antiparkinsonians, antipsychotics, antiepileptic drugs, and medications for bladder control:
According to a study in the Journal of American Medical Association, adults aged 55 and older were nearly 50% more likely to develop dementia if they took just one anticholinergic daily for three years.[03] Additionally, other studies that link anticholinergics to dementia have found that common over-the-counter antihistamines, such as Benadryl and Vicks NyQuil, are linked with higher rates of dementia.[04]
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Benzodiazepines are a class of medications often prescribed to seniors for anxiety and insomnia, according to the U.S. Department of Justice Drug Enforcement Administration. Various studies, including one from the Journal of Clinical Neurology, highlight a substantial rise in dementia risk while taking the following types of benzodiazepines:
This risk appears to be more pronounced for individuals who took higher doses of benzodiazepines for extended durations.[05]
If you’re helping a loved one manage any of these medications, it’s worth conversing with their doctor. Discuss balancing the benefits of these drugs against the potential risk of dementia. Understanding what prescription drugs affect dementia could lead to safer medication choices, particularly for our vulnerable seniors.
Due to physiological changes associated with aging, certain medications can affect older adults differently. The following physiological and lifestyle factors mean that older adults often require different dosing regimens and careful monitoring when using these medications to minimize the risk of adverse effects.
The liver is the primary organ responsible for metabolizing medications. As people age, liver function declines, leading to slower drug metabolism. Medications may stay in the body longer, increasing the risk of side effects or toxicity.
Older adults generally have a higher body fat percentage and lower muscle mass. Fat-soluble (lipophilic) medications, such as certain sedatives or antidepressants, may accumulate in this increased fat tissue. This accumulation can lead to a prolonged half-life, meaning the drugs stay in the body longer. They may also be released slowly, potentially causing prolonged effects or toxicity.
Aging can affect the number and sensitivity of receptors for various medications, leading to increased or decreased effectiveness and changes in side effects.
The central nervous system becomes more sensitive with age, making older adults more susceptible to the effects of medications that act on the brain, such as anticholinergics, antidepressants, and benzodiazepines.
The liver is crucial for metabolizing medications. Aging can reduce the liver’s size and blood flow, slowing down the enzyme activity that breaks down drugs and making medications linger longer in the system.
The kidneys are crucial for excreting medications. With age, kidney function typically declines, resulting in slower drug clearance. This can cause medication to accumulate in the body, leading to potential toxicity.
Older adults often have lower levels of serum albumin and other proteins. Many medications bind to proteins in the bloodstream. With fewer binding proteins available, the amount of unbound, active drug can increase, potentially intensifying its effects.
Older adults are more likely to have multiple chronic health conditions and take several medications simultaneously, which increases the risk of drug interactions and adverse effects.
“Chemo brain,” which has symptoms similar to dementia, is a term referring to cognitive and memory problems associated with cancer and chemotherapy treatments. Despite the similarities, chemo brain is typically reversible once a patient’s health improves, unlike dementia.
While dementia and chemo brain both result in memory loss, they are different in many ways. Dementia leads to gradual cognitive changes and is incurable. Chemo brain, on the other hand, is directly linked to cancer or its treatment and often improves over time. Notably, people with chemo brain are typically aware of their memory lapses and can recall memories with prompting, which isn’t the case for dementia patients. Additionally, chemo brain doesn’t typically affect speech patterns or lead to hallucinations and wandering, which are common dementia symptoms.
More research is still needed to confirm the link between chemotherapy and dementia. However, some studies do suggest that chemotherapy treatment could lead to cognitive decline and potential dementia.[06] Factors such as a patient’s age, sex, weight, diet, chronic inflammation, types of chemotherapy, and type of cancer can all significantly influence these results. For elderly patients who are more susceptible to chemotherapy-related toxicities, chemotherapy can potentially affect their quality of life.
Read more: Chemo Brain and Dementia: What’s the Connection?
If you’re uncertain about your loved one’s exposure to drugs linked to dementia, bring all their medications to their next doctor’s appointment for review. Remember to include over-the-counter (OTC) drugs and prescriptions. Remember that a geriatric-specialized doctor (geriatrician) can provide valuable insight into your loved one’s medication regimen, thus increasing their health and safety. They can offer information on alternative treatments safer for seniors than the above drugs, which a general practitioner may be unfamiliar with.
American Geriatrics Society. (2019, January, 31). For older people, medications are common; updated AGS Beers Criteria® aims to make sure they’re appropriate, too.
StatPearls. (2023, May 8).Anticholinergic medications.
Coupland, C., Hill, T., and Dening, T. (2019, June, 24).Anticholinergic drug exposure and the risk of dementia: A nested case-control study. JAMA Internal Medicine.
Gray, S., Anderson, M., and Dublin, S. (2015, March).Cumulative use of strong anticholinergics and incident dementia: A prospective cohort study. JAMA Internal Medicine.
He, Q., Chen, X., Wu, T., Li, L., and Fei, X. (2019, January).Risk of dementia in long-term Benzodiazepine users: Evidence from a meta-analysis of observational studies. Journal of Clinical Neurology.
Das, A., Ranadive, N., Kinra, M., Nampoothiri, M., Arora, D., and Mudgal, J. (2020, September). An overview on chemotherapy-induced cognitive impairment and potential role of antidepressants. Current Neuropharmacology.
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