A few years ago, while I was at a family celebration, several people mentioned memory concerns to me.
Some were older adults concerned about the memory of their spouses. Some were adult children concerned about the memory of their parents. And a few were older adults who have noticed some slowing down of their own memory.
“But you know, nothing much that can be done at my age,” remarked one man in his eighties.
Wrong. In fact, there is a lot that can and should be done, if you notice memory or thinking changes in yourself or in another older adult. And you should do it because it ends up making a difference for brain health and quality of life.
First among them: identify medications that make brain function worse.
This is not just my personal opinion. Identifying and reducing such medications is a mainstay of geriatrics practice. Among other reasons, we do find that in some people, certain medications are causing memory loss symptoms — or other cognitive symptoms — to be worse.
And the expert authors of the National Academy of Medicine report on Cognitive Aging agree: in their Action Guide for Individuals and Families, they list “Manage your medications” among their “Top 3 actions you can take to help protect your cognitive health as you age.”
Unfortunately, many older adults are unaware of this recommendation. And I can’t tell you how often I find that seniors are taking over-the-counter or prescription medications that dampen their brain function. Sometimes it’s truly necessary but often it’s not.
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. So it’s worth spotting them whether you are concerned about mild cognitive impairment or caring for someone with full-blown Alzheimers.
Every older adult and family should know how to optimize brain function. Avoiding problem medications — or at least using them judiciously and in the lowest doses necessary — is key to this.
And don’t give anyone a pass when they say “Oh, I’ve always taken this drug.” Younger and healthier brains experience less dysfunction from these drugs. That’s because a younger brain has more processing power and is more resilient. So drugs that aren’t such problems earlier in life often have more impact later in life. Just because you took a drug in your youth or middle years doesn’t mean it’s harmless to continue once you are older.
You should also know that most of these drugs affect balance, and may increase fall risk. So there’s a double benefit in identifying them, and minimizing them.
Below, I share the most commonly used drugs that you should look out for if you are worried about memory problems.
The Four Most Commonly Used Types of Medications That Dampen Brain Function
You can also watch a subtitled video version of this information below.
1. Benzodiazepines. This class of medication is often prescribed to help people sleep, or to help with anxiety. They do work well for this purpose, but they are habit-forming and have been associated with developing dementia.
- Commonly prescribed benzodiazepines include lorazepam, diazepam, temazepam, alprazolam (brand names Ativan, Valium, Restoril, and Xanax, respectively)
- For more on the risks of benzodiazepines, plus a handout clinically proven to help older adults reduce their use of these drugs, 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:
- For insomnia, there is no easy and fast alternative. Just about all sedatives — many are listed in this post — dampen brain function. Many people can learn to sleep without drugs, but it usually takes a comprehensive effort over weeks or even months. This may involve cognitive-behavioral therapy, as well as increased exercise and other lifestyle changes. You can learn more about comprehensive insomnia treatment by getting the Insomnia Workbook (often available at the library!) or something similar.
- 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 aging adults:
- Benzodiazepines increase fall risk.
- These drugs sometimes are abused, especially in people with a history of substance abuse.
- Other things to keep in mind:
- If a person does develop dementia, it becomes much harder to stop these drugs. That’s because everyone has to endure some increased anxiety, agitation, and/or insomnia while the senior adjusts to tapering these drugs, and the more cognitively impaired the senior is, the harder it is on everyone. So it’s much better to find non-benzo ways to deal with anxiety and insomnia sooner, rather than later. (Don’t kick that can down the road!)
2. Non-benzodiazepine prescription sedatives. By far the most commonly used are the “z-drugs” which include zolpidem, zaleplon, and eszopiclone (brand names Ambien, Sonata, and Lunesta, respectively). These have been shown in clinical studies to impair thinking — and balance! — in the short-term.
- Some studies have linked these drugs to dementia. However we also know that developing dementia is associated with sleep problems, so the cause-effect relationship remains a little murky.
- For alternatives, see the section about insomnia above.
- Occasionally, geriatricians will try trazodone (25-50mg) as a sleep aid. It is thought to be less risky than the z-drugs or benzodiazepines. Of course, it seems to have less of a strong effect on insomnia as well.
- Other risks in aging adults:
- These drugs worsen balance and increase fall risk.
3. Anticholinergics. This group covers most over-the-counter sleeping aids, antihistamines such as Benadryl, as well as a variety of other prescription drugs. These medications have the chemical property of blocking the neurotransmitter acetylcholine. This means they have the opposite effect of an Alzheimer’s drug like donepezil (brand name Aricept), which is a cholinesterase inhibitor, meaning it inhibits the enzyme that breaks down acetylcholine.
You may have heard that “Benadryl has long-term side effects on the brain.” That’s because diphenhydramine (brand name Benadryl) is strongly anticholinergic.
A 2015 study found that greater use of anticholinergic drugs was linked to a higher chance of developing Alzheimer’s, and a 2021 Cochrane review found that these drugs may increase the risk of cognitive decline or dementia.
Drugs vary in how strong their anticholinergic activity is. Focus your energies on spotting the ones that have “high” anticholinergic activity. For a good list that classifies drugs as high or low anticholinergic activity, see here. Or, you can look up any of your medications using this handy “anticholinergic burden scale” calculator.
I reviewed the most commonly used of these drugs in this video:
I also cover them in an article here: “7 Common Brain-Slowing Anticholinergic Drugs Older Adults Should Use With Caution.” Briefly, drugs of this type to look out for include:
- 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 Flexeril).
- “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).
There is also one of the popular SSRI-type antidepressants that is known to be quite anticholinergic: paroxetine (brand name Paxil). For this reason, geriatricians almost never prescribe this particular anti-depressant.
For help spotting other anticholinergics, ask a pharmacist or the doctor, or check your medications with this handy “anticholinergic burden scale” calculator.
Alternatives to these drugs really depend on what they are being prescribed for. Often non-drug alternatives are available, but they may not be offered unless you ask. For example, an oral medication for itching can be replaced by a topical cream. Or the right kind of stretching can help with tight muscles.
Aside from affecting thinking, these drugs can potentially worsen balance. They also are known to cause dry mouth, dry eyes, and can worsen constipation. (Acetylcholine helps the gut keep things moving.)
4. Antipsychotics and mood-stabilizers. In older adults, these are usually prescribed to manage difficult behaviors related to Alzheimer’s and other dementias. (In a minority of aging adults, they are prescribed for serious mental illness such as schizophrenia. Mood-stabilizing drugs are also used to treat seizures.) For dementia behaviors, these drugs are often inappropriately prescribed. All antipsychotics and mood-stabilizers are sedating and dampen brain function. In older people with dementia, they’ve also been linked to a higher chance of dying.
- Commonly prescribed antipsychotics are mainly “second-generation” and include risperidone, quetiapine, olanzapine, and aripiprazole (Risperdal, Seroquel, Zyprexa, and Abilify, respectively).
- The first-generation antipsychotic haloperidol (Haldol) is still sometimes used.
- Valproate (brand name Depakote) is a commonly used mood-stabilizer.
- Alternatives to consider:
- Alternatives to these drugs should always be explored. Generally, you need to start by properly assessing what’s causing the agitation, and trying to manage that. A number of behavioral approaches can also help with difficult behaviors. For more, see this nice NPR story from March 2015. I also have an article describing behavioral approaches here: 7 Steps to Managing Difficult Dementia Behaviors (Safely & Without Medications).
- For medication alternatives, there is some scientific evidence suggesting that the SSRI citalopram may help, that cholinesterase inhibitors such as donepezil may help, and that the dementia drug memantine may help. These are usually well-tolerated so it’s often reasonable to give them a try.
- If an antipsychotics or mood-stabilizer is used, it should be as a last resort and at the lowest effective dose. This means starting with a teeny dose. However, many non-geriatrician clinicians start at much higher doses than I would.
- Other risks in older adults:
- Antipsychotics have been associated with falls. There is also an increased risk of death, as above.
- Caveat regarding discontinuing antipsychotics in people with dementia: Research has found that there is a fair risk of “relapse” (meaning agitation or psychotic symptoms getting worse) after antipsychotics are discontinued. A 2015 study of nursing home residents with dementia concluded that antipsychotic discontinuation is most likely to succeed if it’s combined with adding more social interventions and also exercise.
- You can learn more about medications to treat dementia behaviors in this article: “5 Types of Medication Used to Treat Difficult Dementia Behaviors“
A Fifth Type of Medication That Affects Brain Function
Opioid pain medications. Unlike the other drugs mentioned above, opioids (other than tramadol and meperidine) are not on the Beer’s list of medications that older adults should avoid. That said, they do seem to dampen thinking abilities a bit, even in long-term users. (With time and regular use, people develop tolerance so they are less drowsy, but seems there can still be an effect on thinking.) As far as I know, opioids are not thought to accelerate long-term cognitive decline.
- Commonly prescribed opiates include hydrocodone, oxycodone, morphine, codeine, methadone, hydromorphone, and fentanyl. (Brand names depend on the formulation and on whether the drug is mixed with acetaminophen.)
- Tramadol (brand name Ultram) is a weaker opiate with weaker prescribing controls.
- Many geriatricians consider it more problematic than the classic Schedule II opiates listed above, as it interacts with a lot of medications and still affects brain function. It’s a “dirty drug,” as one of my friends likes to say.
- Alternatives depend on what type of pain is present. Generally, if people are taking opiates then they have pain that needs to be treated. However, a thoughtful holistic approach to pain often enables a person to get by with less medication, which can improve thinking abilities.
- For people who have moderate or severe dementia, it’s important to know that untreated pain can worsen their thinking. So sometimes a low dose of opiate medication does end up improving their thinking.
- Other risks in older adults:
- There is some risk of developing a problematic addiction, especially if there’s a prior history of substance abuse. But in my experience, having someone else — usually younger — steal or use the drugs is a more likely problem.
Where to Learn About Other Drugs That Affect Brain Function
Many other drugs that affect brain function, but they are either not used as often as the ones above, or seem to affect a minority of older adults.
Notably, there has been a lot of concern in the media about statins; these are commonly used cholesterol-lowering medications, such as simvastatin and atorvastatin (brand names Zocor and Lipitor, respectively).
But this concern seems to be unfounded: a meta-analysis published in 2015 could not confirm an association between statin use and increased cognitive impairment. In fact, a 2016 study found that statin use was associated with a lower risk of developing Alzheimer’s disease.
This is not to say that statins aren’t overprescribed or riskier than we used to think. And it’s also quite possible that some people do have their thinking affected by statins. But if you are trying to eliminate medications that dampen brain function, I would recommend you focus on the ones I listed above first.
Personally, I do not worry about the cognitive effect of statins; I feel my patients are much more likely to be harmed by regularly using something like Benadryl, which is anticholinergic.
For a comprehensive list of medications identified as risky by the experts at the American Geriatrics Society, be sure to review the most recent Beers Criteria.
You can also learn more about medications that increase fall risk in this article: 10 Types of Medications to Review if You’re Concerned About Falling.
What to Do if You or Your Relative Is On These Medications
So what should you do if you discover that your older relative — or you yourself — are taking some of these medications?
If it’s an over-the-counter anticholinergic, you can just stop it. Allergies can be treated with non-sedating antihistamines like loratadine (brand name Claritin), or you can ask the doctor about a nasal steroid spray. “PM” painkillers can be replaced by the non-PM version, and remember that the safest OTC analgesic for older adults is acetaminophen (Tylenol).
If you are taking an over-the-counter sleep aid, it contains a sedating antihistamine and those are strongly anticholinergic. You can just stop an OTC sleep aid, but in the short term, insomnia often gets worse. So you’ll need to address the insomnia with non-drug techniques. (See here for more: 5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia.)
You should also discuss any insomnia or sleep problems with your doctors — it’s important to rule out pain and serious medical problems as a cause of insomnia — but be careful: many of them will prescribe a sleeping pill, because they haven’t trained in geriatrics and they under-estimate the risks of these drugs.
If one or more of the medications above has been prescribed, don’t stop without first consulting with a health professional. You’ll want to make an appointment soon, to review the reasons that the medication was prescribed, alternative options for treating the problem, and then work out a plan to reduce or eliminate the drug.
I explain how to find a geriatric doctor near you here: How to find a geriatrician — or a medication review — near you.
To prepare for the appointment, try going through the five steps I describe in this article: “How to Review Medications for Safety & Appropriateness.”
I also recommend reviewing HealthinAging.org’s guide, “What to Ask Your Health Provider if a Medication You Take is Listed in the Beers Criteria.”
Remember, when it comes to maintaining independence and quality of life, nothing is more important than optimizing brain function.
We can’t turn back the clock and not all brain changes are reversible. But by spotting problem medications and reducing them whenever possible, we can help older adults think their best.
Now go check out those medication bottles, and let me know what you find!
We are at 200+ comments, so comments on this post have been closed. If you have a question about your medications, we recommend consulting with your usual health provider or discussing with a pharmacist.
Susan says
Thanks for the article. I am so disheartened to find out that Trazadone is an anticholinergic. I have chronic problems with insomnia despite working out a lot and following all the other sleep hygiene practices. Is there something I could take to mitigate the harmful effects of Trazadone? Is it ok to take if I stop for several months at a time? Is melatonin harmful? It doesn’t work as well for me but maybe I should try it again.
Thanks for entertaining my questions.
Leslie Kernisan, MD MPH says
So, according to the list of anticholinergic medications that I link to in this article, trazodone is classified as having “low” anticholinergic activity.
In geriatrics, we usually focus our concern on the medications that are in the “medium/high” anticholinergic activity column. We do actually prescribe trazodone sometimes; of all the medications that are sleep-inducing, it seems less likely to harm than our other options.
But of course, the best is to help a person sleep better without using any medications. Melatonin does appear safe, but since it’s a supplement and poorly regulated in the US, your mileage may vary. Otherwise, for non-drug ways to sleep better, you might want to try a cognitive-behavioral therapy program for insomnia (CBT-I). Even the online programs (Sleepio, SHUTi) have done well in research studies, and they seem to be more effective than sleep hygiene alone.
Good luck, I hope you find a way to sleep better soon!
Susan says
Your response is very helpful. Thank you so much for being so accessible for questions. I am 54 years old, and have friends in the roughly the same age range who all take trazadone. So are you saying it is fairly safe to take on an on-going basis for women in our age range? Also, one has a brain injury from 20 years ago. She has a lot of difficulty sleeping bc of it and was recently switched to trazadone. Are there any special considerations in taking trazadone on an on-going basis when you have a brain injury? She has to avoid over-stimulation and get extra rest, but otherwise she functions fine.
Thanks again for your valuable perspective.
Leslie Kernisan, MD MPH says
Honestly, I think we don’t really know how safe it is to take trazodone long-term. In geriatrics practice, we consider it safer than most alternatives (with the exception of melatonin). However, our patients are considerably older than you are, so we don’t have experience with what happens when people take trazodone for 20 or 30 years, and the considerations when prescribing medication are different when people seem to have a more limited life expectancy.
What is known about trazodone and other sleep medications for older adults is summarized here:
Review of Safety and Efficacy of Sleep Medicines in Older Adults
If your friend has a history of traumatic brain injury, she may want to consult with a clinician who specializes in the long-term care of such people. Again, I doubt there is actual published research on trazodone in people like her, but she could check PubMed or Google Scholar and see if something turns up.
Again, the safest option is always to find ways to resolve or manage insomnia without medication. Good luck!
Kathy says
You mentioned sedating antihistamines which should be avoided for Alzheimer’s patients. My mother who has Alzheimer’s disease was prescribed with some medicines by her family doctor for addressing running nose and serious cough. We are told that some pills are antihistamines and will make her feel drowsy/sleepy. In fact, my mother talked in the dream and sometimes had hand movements. Are these pills sedating antihistamines? I can’t find any information the Internet that explains whether or not the pills are sedating. Is there a full list that shows this important formation? The name of the pill on the package label is Slow-Theo. Do you have any idea? Thank you.+
Leslie Kernisan, MD MPH says
Slow-theo appears to be theophylline. It is not a sedating antihistamine. This is a drug that is no longer used very often in the US, and is FDA approved for the treatment of asthma and COPD. I believe it’s not sedating, instead it’s a bit activating and stimulating, and actually can cause arrhythmias, insomnia, tremors, and other “excitatory” type of side-effects. It is on the Beer’s list of medications that older adults should avoid or use with caution.
louise bem says
I had problems with lyrica. I could t remember the simplest things, had difficulty putting sentences together, would space out for short periods of time and was often confused. When I stopped lyrica and changed to neurotin the problems stopped. the lyrica was better for pain but unfortunately not for my brain..
Leslie Kernisan, MD MPH says
Pregabalin (brand name Lyrica) is an anti-convulsant drug that is prescribed to treat a variety of conditions, including nerve pain, fibromyalgia, and anxiety.
It is known to cause short-term cognitive side-effects in a fairly substantial proportion of users. It has only been used in the US since 2005 and so as far as I know, it’s too soon to know if it’s associated with longer-term cognitive risk.
Zac says
Hi, I got diagnosed with Bipolar disorder in 2014 after a break with my fiance, I went to the doctor and told him I am depressed and he gave me antidepressant after that I went into mania and psychosis…I got started with Olganzapine for 1 year, after that I tried to stop smoking cigarette I asked the doctor and he gave me Chantix I again went into Mania and psychosis….than I became fine and started having lamictal which use to make me high and I went to the doctor again and asked them to help me stop smoking and he gave me Zyban…zyban again took me into mania and psychosis and I suffered again….for the past year I have been on Carbamazepine and Dapakon 1000 mg and 200 mg, but when I stopped 200 mg and had Zolpidem cause I couldnt sleep I went straight into mania and mild psychosis….I have had 4 episodes because of medicines…I have realised that ANY MEDICATION WHICH SSRI Or Antidepressant is like poison for my mind…….I am on two mood stabilisers is it effecting my mind and will it effect my memoryin the long run???
Leslie Kernisan, MD MPH says
So, you have a dignosis of bipolar disorder and it also sounds like you’ve been having a lot of mental health symptoms recently. So weighing the benefits and risks of mood stabilizers is different for you than for many older adults, who are usually given these drugs to manage difficult dementia behaviors.
You don’t say how old you are, but for people with significant mental health issues, what is usually most important is to stabilize their symptoms, to avoid mania and psychosis. Once you are stable, you will be in a better position to talk with your psychiatrist (and perhaps get a second opinion) regarding the long-term risk of your medications and what alternatives might be available.
Studies done in Taiwan found that lithium treatment was not associated with increased risk of Alzheimer’s disease whereas treatment with valproic acid was. A psychiatrist or other expert should be able to help you delve further into the related scholarly literature. But again, I would encourage you to first focus on stabilizing your symptoms. Good luck!
Terry Tipton says
What about melatonin for sleep problems? Is it safe?
Leslie Kernisan, MD MPH says
Melatonin does appear to be safe. I have some more information about it in this article: 5 Top Causes of Sleep Problems in Aging, & Proven Ways to Treat Insomnia.
Peter Simmons says
It seems the sooner canabis is legalised and proper use of it is made, especially for older people who are often taking cocktails of drugs from their GP, some of which are to treat side-effects of others. With no side effects and a range of conditions cannabis can treat, including; glaucoma, depression, nervousness, insomnia, various kinds of pain, not to mention cancer, epilepsy and and other conditions now being investigated by cannabis researchers.
Seems to me the perfect drug for the old. Only pharmaceutical companies would lose out, which is probably why they have been both spreading misinformation about cannabis while at the same time racing to develop ‘proprietary’ medicines using the cannabinoid active ingredients which they are unable to patent, being a natural plant that grows as a weed on every continent.
Leslie Kernisan, MD MPH says
I agree that cannabis could be promising, but first I would want to know more about the long-term effects on older adults, esp as regards memory, thinking, and falls. This is especially important if the situation suggests a person might take the medication for years.
Historically most research on cannabis has been done on younger people, but now research is starting to be done on older adults.
Marijuana Use in the Elderly: Implications and Considerations
The Increasing Use of Cannabis Among Older Americans: A Public Health Crisis or Viable Policy Alternative?
Hopefully, more research findings will become available in the next few years.
Lisa says
Excellent blog. Thanks very much. I am in the process of tapering my 83 year old mother (with mild dementia) off of Ranitidine. She also takes 40 mg of Nexium (prescribed several years ago for acid reflux) and 12 hour Allegra (Fexofenadine) twice daily. I see that Fexofenadine is listed as “controversial” on the drug list. Should I speak to her MD about moving her to Claritin or another alternative? What about the Nexium? Once she is off of the Ranitidine, I would like to slowly taper her off of the Nexium to see if she really still needs to take it. Thoughts?
She has been taking 4 mg of Medrol daily for 2 years which her internist believes helped her cognitively. We have been working with a rheumatologist to taper her off of the Medrol because we believed it contributed to her muscle weakness, recurrent UTIs and speaking issues. Now down to 1 mg and her muscles are much better. Does long term use of 4 mg of Medrol daily contribute to her dementia issues? Alternatively, have you heard of Medrol (in that dosage) helping with dementia – i.e. more alert, etc….? She has good long term memory (short term memory is shot) and needs round the clock care but is aware of everything going on despite inability to express herself.
Leslie Kernisan, MD MPH says
I’ll start with the Medrol question. This is methylprednisolone, a glucocorticoid (also known as a type of steroid), very similar to prednisone. Glucocorticoids are potent anti-inflammatories. By far the most common chronic use is to treat auto-immune diseases, but they do cause quite serious side-effects when used chronically, including some of the problems you mention.
Prednisone and other corticosteroids
Honestly, I have never heard of glucocorticoids being used to improve cognitive function, in fact they are known to cause a variety of cognitive and psychiatric side-effects. If your internist has recommended this, I would suggest asking him or her to provide you with information on why they believe this is likely to be helpful. I just took a look in the literature and couldn’t not find any justification for such an approach, but it’s possible that there are other aspects of your mother’s health history that might justify such an approach.
Psychiatric complications of treatment with corticosteroids: review with case report
Glucocorticoids do need to be tapered down carefully, once a person has been taking them for a significant length of time; rheumatologists are usually quite experienced in helping people taper these medications.
Regarding the treatment of potential GERD (gastroesophageal reflux disease), you may want to ask the doctor why she is on both ranitidine (a histamine 2 receptor agonist) and Nexium (a proton pump inhibitor). Usually something like ranitidine is used for mild cases, and studies find that it declines in effectiveness in people who use it continuously. For people with severe or persisting symptoms, a PPI such as Nexium is more commonly used. PPIs have been associated with concerning health outcomes in older adults, although there’s been some debate about how serious these are in most people.
Here is a good brochure about tapering PPIs, from the Canadian Deprescribing Network:
You may be at risk: You are currently taking a proton-pump inhibitor (PPI)
For more on treating GERD, here is a review article from the Cleveland Clinic:
GERD: Diagnosing and treating the burn
It would likely be reasonable for you to review her GERD history with her doctors, to make sure she was correctly diagnosed and that you’ve considered all available lifestyle treatments.
In terms of her Allegra, you could certainly try switching to Claritin or a nasal steroid. But I would say it’s a higher priority to help her taper the Medrol (assuming that is what you decide to do, and I would only recommend continuing such a high-risk medication if there were very compelling reasons to do so).
Generally it’s best to work on changing one medication at a time, especially in people with dementia who may have difficulty expressing any changes in symptoms clearly.
I do think it’s good that you are revisiting the purpose and value of all her medications. Good luck shepherding her through this process.
Dan says
Just curious about marijuana, tryptophan, valerian, chamomile and magnesium for insomnia/anxiety. Do any of these potentially exacerbate risk for dementia?
Leslie Kernisan, MD MPH says
I took a quick look in the medical literature, there doesn’t seem to be much published research on marijuana, valerian, chamomile as a risk factor for dementia.
Tryptophan is an amino acid precursor to serotonin and melatonin. I’m not aware of tryptophan supplementation being related to dementia risk; in fact this article suggests that supplementation may improve cognition (at least short-term) in some people: Influence of Tryptophan and Serotonin on Mood and Cognition with a Possible Role of the Gut-Brain Axis
Some research has found that low magnesium levels are associated with a higher risk of Alzheimers, but g 2017 study found that both high and low serum magnesium levels were associated with a higher risk of dementia. This suggests that too little magnesium is a problem and that too much might be a problem as well. Whether the amount taken as a supplement, regularly or nightly for insomnia, would be a serious risk…I think it’s probably not yet known.
I comment further on the use of magnesium for insomnia here.
Probably the best and safest way to try to reduce insomnia and anxiety is to use non-drug methods, preferably in combination (e.g. cognitive behavioral therapy along with exercise and other lifestyle changes).
Marilyn says
Does “Gabapentin” cause problems too??
Leslie Kernisan, MD MPH says
Gabapentin is technically an “anticonvulsant” (i.e. an antiseizure medication) but was heavily marketed for pain and nerve pain, and that tends to be the most common reason I see it prescribed in older adults.
Some anticonvulsants are sedating or associated with fall risk. Gabapentin seems to be “better tolerated” than most anticonvulsants, meaning it causes fewer side-effects. I don’t know of any research linking it to an increased dementia risk, but one study did find that it caused mild cognitive effects.
This is not so surprising when you think about it; the whole point of antiseizure medication is to reduce the activity of neurons in the brain.
I think the bigger problem with gabapentin is that in many randomized studies, it turns out to not be all that effective for the conditions that it is often prescribed for. In short, it seems less likely to be harmful than many medications I mention in this article, but it’s also not clear that most people benefit from taking it.
Kathy says
Re SSRIs mentioned in your article, our family doctor recently prescribed my mom with Brintellix, which is said to be a SSRI. Starting with 5mg for trial for 8 days, and afterwards increased to 10mg each day after no side effect was shown during the trial period. Before this medication, my mom suffers from dizziness and serious fatigue almost every day with low mood. Today is the 4th day on 10mg. We observed that dizziness and fatigue issue become less serious/frequent and she restarts walking as exercise – though she feel tired after exercise each time.
Her doctor said that those physical symptoms were actually due to depression. Is it true? Will this drug impact on my mom’s Alzheimers disease?
Thanks a lot.
Leslie Kernisan, MD MPH says
The tricky thing about dizziness and fatigue is that SO many things can cause them, in an older person. So, it’s important to check carefully for other medical causes of these problems, before concluding they are due to depression. Depression is also usually associated with one of two key symptoms: frequent sadness or losing interest in things that used to give pleasure.
To evaluate fatigue and/or dizziness in an older person, we often check bloodwork including a CBC, a metabolic panel, and thyroid function. (We also have to ask about concerning related symptoms using questions, and physically examine the person. I explain commonly used blood tests here:
Understanding Laboratory Tests: 10 Commonly Used Blood Tests for Older Adults
What is good is that your mother seems to be improving. Hard to say whether it is due to her new SSRI; usually they take 4-8 weeks to have an effect.
Also, you should know that the scientific research generally finds that antidepressants work no better than placebo, for treatment of depression in people with dementia. There is an excellent review article available here:
What is the therapeutic value of antidepressants in dementia? A narrative review
In terms of side-effects or potential harms: Vortioxetine (brand name Brintellix in some countries) is one of the newest SSRIs, so it has less of a track record than some of the other SSRIs we often use in geriatrics. Here is a recent review I found, on this newer SSRI:
Profile of vortioxetine in the treatment of major depressive disorder: an overview of the primary and secondary literature
SSRIs in general don’t seem to have a big effect on cognition in Alzheimer’s, although one study found that citalopram was associated with a little additional cognitive decline (on the other hand, it also decreased agitation a bit).
However, SSRIs have been associated with increased fall risk.
So, generally I recommend people pay close attention when trying antidepressants in dementia. If the person is not clearly better on the drug, it may be safer to discontinue it.
If you become concerned again about dizziness or fatigue, I would recommend asking the doctor more questions about what else it might be, and what tests have been done to rule out other possibilities. Good luck!
Kathy says
Thank you so much for providing those useful articles. We will keep monitoring my mom’s condition and talk to the doctor promptly in case of any change.