These Drugs May Cause Memory Loss

Some people dismiss memory problems as a normal part of aging, but what most people do not know is that memory loss can be caused by prescription drugs and medications. A Place for Mom expert and geriatrician Leslie Kernisan, MD, provides some guidance about the types of brain-slowing medication to avoid if you’re worried about memory loss for yourself or your aging loved one.

While people may think that not much can be done to improve memory in seniors, Dr. Kernisan discusses that there are actually steps that can be taken to determine whether memory problems like Alzheimer’s or dementia can be helped, or even fixed. In fact, the brain has the ability to grow new brain cells and reshape their connections throughout life. Dr. Kernisan notes:

“There is a lot that can and should be done, if you notice memory or thinking changes in yourself or in another older adult. You should do it because it ends up making a difference for brain health and quality of life. And what especially troubles me is that most of these older adults — and their families — have no idea that many have been linked to developing dementia, or to worsening of dementia symptoms. Every older adult and family should know how to optimize brain function, and avoiding problem medications, or at least using them judiciously and in the lowest doses necessary, is key to this.”

Identifying medications that make brain function worse should be at the top of the list of things to review. According to Dr. Kernisan, many seniors are taking over-the-counter or prescription medications that dampen brain functioning, which is often not necessary.

4 Medications That Alter Brain Function

Dr. Kernisan shares some of the most commonly used drugs that you should be on the lookout for if you are worried about memory problems:

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1. Benzodiazepines

These medications are prescribed to help with sleep or anxiety problems, but they are also habit-forming and have been associated with developing dementia.

Commonly prescribed benzodiazepines include:

• Lorazepam (brand name Ativan)
• Diazepam (brand name Valium)
• Temazepam (brand name Restoril)
• Alprazolam (brand name Xanax)

For more on the risks of benzodiazepines, see “How You Can Help Someone Stop Ativan.”

*Note that it can be dangerous to stop benzodiazepines suddenly. These drugs should always be tapered, under medical supervision.

Alternatives to Consider:

Dr. Kernisan notes that there is no easy and fast alternative for insomnia, as just about all sedatives dampen brain function. Many people can learn to sleep without drugs, but it usually takes a dedicated effort over weeks, or even months. This may involve cognitive-behavioral therapy, as well as increased exercise and other lifestyle changes.

For anxiety, there is also no easy replacement. However, there are some drug options that affect brain function less, such as SSRIs (e.g. sertraline and citalopram, brand names Zoloft and Celexa). Cognitive behavioral therapy and mindfulness therapy also helps, if sustained.
Even if it’s not possible to entirely stop a benzodiazepine, tapering to a lower dose will likely help brain function in the short-term.

Other Risks in Seniors:

• Benzodiazepines increase fall risk
• These drugs sometimes are abused, especially in people with a history of substance abuse

Things to Keep in Mind:

If a person does develop dementia, it becomes much harder to stop these drugs. So it’s much better to find non-benzo ways to deal with anxiety and insomnia sooner, rather than later.

2. Non-Benzodiazepine Prescription Sedatives

Also known as the “z-drugs,” these commonly used sleeping aides have been shown to impair both thinking and balance:

• Zolpiderm (brand name Ambien)
• Zaleplon (brand name Sonata)
• Eszopiclone (brand name Lunesta)

While studies have linked these drugs to dementia, their direct relationship with sleeping makes the cause-effect relationship a little murky, according to Dr. Kernisan. See section one for the alternatives to consider for these drugs.

Things to Keep in Mind:

These drugs worsen balance and increase fall risk.

3. Anticholinergics

The anticholinergics include most of the over-the-counter sleeping medicines, as well as many of the prescription drugs. Since this group blocks the neurotransmitter, acetylcholine, they have the opposite effect of an Alzheimer’s drug like Donepezil (Aricept) — a cholinesterase inhibitor, that works against the enzyme that breaks down acetylcholine. In fact, according to Dr. Kernisan, a 2015 study found that greater use of anticholinergics was linked to a higher chance of developing Alzheimer’s.

Since drugs vary in strength, it’s important to determine whether your medicine, or you family member’s medicine, is one of the drugs that has ‘high’ anticholinergic activity. Here is a list that classifies high and low anticholinergic activity. Dr. Kernisan’s Nextvenue article, “7 Common Drugs That Are Toxic for Your Brain” is a good place to find out which drugs put you or your loved one most at risk. Here are some very common ones to be aware of:

• Sedating antihistamines, such as diphenhydramine (brand name Benadryl)
• The “PM” versions of over-the-counter analgesics (e.g. Nyquil, Tylenol PM); the “PM” ingredient is usually a sedating antihistamine
• Medications for overactive bladder, such as the bladder relaxants oxybutynin and tolterodine (brand names Ditropan and Detrol, respectively)
  • Note that medications that relax the urethra, such as tamsulosin or terazosin (Flomax and Hytrin, respectively) are NOT anticholinergic. So they’re not risky in the same way, although they can cause orthostatic hypotension and other problems in older adults. Medications that shrink the prostate, such as finasteride (Proscar) aren’t anticholinergic either.
• Medications for vertigo, motion sickness, or nausea, such as meclizine, scopolamine, or promethazine (brand names Antivert, Scopace, and Phenergan)
• Medications for itching, such as hydroxyzine and diphenhydramine (brand names Vistaril and Benadryl)
• Muscle relaxants, such as cyclobenzaprine (brand name Flexaril)
• “Tricyclic” antidepressants, which are an older type of antidepressant which is now mainly prescribed for nerve pain, and includes amitryptiline and nortriptyline (brand names Elavil and Pamelor)

Alternatives to Consider:

Checking with a doctor or pharmacist for non-drug alternatives is always a smart way to go as they may not be available unless you ask.

Things to Keep in Mind:

In addition to affecting thinking, these drugs can affect balance. Dry mouth, dry eyes and constipation can also be side affects.

4. Antipsychotics and Mood-Stabilizers

These medications are usually prescribed to help manage difficult behaviors caused by Alzheimer’s and dementia, and sometimes mental illnesses, such as schizophrenia. A New York Times story recently discussed how these drugs are often inappropriately prescribed and are even linked to a higher chance of death.

Common antipsychotics and mood-stabilizers include:

• Risperidone (brand name Risperdal)
• Quetiapine (brand name Seroquel)
• Olanzapine (brand name Zyprexa)
• Aripiprazole (brand name Abilify)
• Haloperidol (brand name Haldol)
• Valproate (brand name Depakote)

Alternatives to Consider:

Dr. Kernisan that it’s important to assess what’s causing the problem and try and manage treatment without drugs, if possible. For example, behavioral approaches have shown to be an effective treatment, in many instances. There is scientific evidence suggesting that the following may help:

• SSRI citalopram
• Cholinesterase inhibitors (such as donepezil)
• Memantine

Things to Keep in Mind:

Antipsychotics have been associated with falls, and there is an increased risk of death.

What to Do if Your Loved One is at Risk

It is important to remember that good brain function is crucial for maintaining independence and quality of life. If you are worried that your loved one is at risk for altered brain function as a result of medications, it’s important to consult a doctor or pharmacist. In many cases, the medication can be dropped or changed; or behavioral therapies may be the right choice for you. But never stop medications without talking to a health professional first as you don’t want to compromise your loved one’s care.

About Dr. Leslie Kernisan, MD:

Leslie Kernisan, MD, is a practicing geriatrician who believes that it shouldn’t be so hard for older adults and families to get the right kind of help with health concerns. For more practical tips — and to get her free quick guide to checking aging parents — visit her new blog at: HelpingOlderParents.com.

Do you have experience with — or stories about — how prescription drugs may cause memory loss? Share them with us in the comments below.

Related Articles:

• 5 Common Medication Mistakes and How to Avoid Them
• 5 Medication Safety Tips for Seniors
• How to Think Like a Geriatrician about Senior Medication