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.
SV says
Naturally, Haldol (and the slightly better second gen anti-psychotics) and Ativan are regularly prescribed for dementia patients in just about every facility. While they can help in severe psychotic and/or dangerously aggressive behavior, they are more often used as chemical restraints to immobilize and zombify people.
We need reform and it doesn’t look like it’s coming.
I am puzzled by your friend’s reference to “dirty drugs.” The US is on a media driven frenzy war against pain relief. Worry about addiction in a dementia patient is pretty pointless, isn’t it?
Leslie Kernisan, MD MPH says
My colleague’s “dirty drug” comment refers to the fact that tramadol interacts with many medications and affects brain function; it was not a reference to addiction risk. Research suggests that there is some risk of abuse for tramadol; probably less than for opiates but it also seems to depend on how the person metabolizes the drug.
Agree that addiction concerns may be less important if a person has dementia and/or limited life-expectancy. Also important to consider whether someone else in the household might divert or abuse an older person’s medications.
Janice E Stenman says
I noticed that you did not address the war on pain relief. That is a huge problem. I dont even know where to start, I am so angry at the direction that medicine is taking when dealing with the problems that “elderly” patients face. Often doctors hands are tied because politicians seem to be driving medical care.
Because 72,000 drug addicts killed themselves last year, often with illegally obtained drugs, the millions of people who live with excruciating pain are forced to go without proper pain relief. And to top it off, they have to pee in a cup like criminals.
In adon, we now have the Beers list to contend with. While the Beers creators preface it with discaimers…I am sure so they dont get sued…doctors are faced with trying to help their patients while being more and more limited on what they can prescribe without being sanctioned.
Glaringly absent from the top 100 drugs or any other spot on the Beers list is the pharmaceutical cash cow statins. Proven to trigger type 2 diabetes, sever muscular and skeletal pain, peripheral neuropathy and a host of other symptoms, some life threatening. Other drugs with far fewer adverse symptoms are on the Beers list and even in the top 100, those deemed so bad for the elderly that they should never under any circumstances be prescribed for the elderly. In addition, it is not uncommon for there to be no viable alternative, nitrofurontoine being a prime example.
Incidently, I am a 74 year old woman who has been taking xanax, nitrofurontoine. Oxybutinin. Cyclobenzaprine
Oxycodone and a few other drugs you mention. I have been taking them for years. Amazingly, I am not addicted nor have I suffered any cognitive decline.
By the way, if I ever do develop dementia, I want to be zombified.
Leslie Kernisan, MD MPH says
Well, this is not meant to be an article on painkillers. How to manage significant pain is a complicated topic, especially now with the current concerns about opiate overuse and addiction risk. You are right that some people live with a lot of chronic pain and it has become harder and harder for them to get the medications that they may need. This is an important issue but beyond the scope of this article.
Re the Beer’s list, I know their process for reviewing medications and revising the list is very careful. The list is currently being revised again, and I have invited a UCSF colleague involved in the Beer’s list to discuss it on an upcoming podcast episode. Perhaps we can address your statin comment during the interview.
Re your preferences if you ever develop dementia, I hope you have discussed them with your family and health providers, and documented them in your advance care planning documents. By wanting to be “zombified,” I assume you mean that pain and symptom control would be your highest priority, and that you don’t mind being sedated or taking other related risks. If that is your preference, I hope those caring for you will be able to honor it.
Zachary Estright says
I hope you’re still watching and replying to this thread. But, I’ve been taking 20mg fluoxetine along with 100mg trazodone for about 6-8 months now and at first it felt like everything just got better in the first week. Now my depression is starting to affect me again and even though I’m finally sleeping and happy to be sleeping I’m starting to lose track of what’s a dream and what’s reality and that is not helping my memory. I also have had a lot of concussions growing up when I was in 8th grade they said I’m not allowed to play contact sports anymore. They said something about minor brain damage in the part of the brain that controls emotion. My daily memory is pretty bad as well sometimes my girlfriend will tell me that I’ve asked what was for dinner 3 times within a span of an hour or two. Im only 23 but I want to know my best options to explore to improve my quality of life in order for me to be better for my family.
Leslie Kernisan, MD MPH says
Your situation sounds quite complicated and also you are much much younger than the people I usually care for. I have no idea what is the best approach to evaluating and managing someone with your history and symptoms.
I would recommend you consult with a clinician with more experience addressing mental health concerns and other possible consequences of concussions in younger people.
You might also want to look online to see if you can find a community of younger adults coping with post-concussion issues. A community of people with similar health concerns can be an excellent source of support and also ideas on how to improve one’s health problem. Good luck!
Danielle says
I have a question because I am worrying because I have a lot of problems with my health/cognitive problems. I want to try something for my sleep problems and anxiety/mood problems instead of the zopiclon I am using now for 4 years and oxazepam for the last ten years. I have a difficult situation so I hope you can give me some advice. I have split the dose zopiclon so now I use 7.5 mg for sleep and I also use half oxazepam because I want to quit with everything. I have had premature menopause at age 35, now 41, with severe symptoms and at that age it is recommended to use hrt. I have tried different forms but it is difficult to balance my hormones. I also have chronic migraines and 24 hours a day visual disturbances and tinnitus attacks. Since quitting my menstruations I have also developed vestibular migraines or something? Sometimes I have mood problems and anxiety (result of premature menopause or the hormones I am using) If I don’t take sleep medications I sleep 5 hours and I wake up with brain fog, migraines, tinnitus. Good sleep is essentil for me. Zopiclon gave me 6.5 hours of sleep. Despite that I also woke up tired with brain fog en never felt like I had a good night sleep because of all the neurological problems. I know that symptoms won’t go away but I have to sleep a good night. I am worrying because my short/long term memory is awfull. My dr. aren’t working together. They sent me for each problem to the next doctor so I have no idea what to do. It is so complex and every dr. has his ow specialism. I want to keep my body and brains in good health. My vitamin B12 was 233 and my dr. sees no problem (range 133-600). Could you give me some advice about the following medications: – I want to try Dekamine or Topimirat for my migraines. Which one is better and safer on the long term ( I am afraid to try these because of the side effects; At the moment I have severe memory/syntax problems) My Dr. wants me to try amitriptyline but I have read about the long term effects so I don’t want to take them. – If I quit zopiclon I want to try trazodone or something else for my sleep. The stress/anxiety problems are another problem but at the moment my sleep is important for me. I would like to try Sertraline or Citalopram but these two can cause sleep problems. So I thought Trazodon could be an option or Wellbutrin for my hyperexitable brain to sleep. Do you think this could be a good option without harming effects on the brain. – Are there natural alternatives? Natural GABA or L-Theanine? Sorry for my bad English (I come from the Netherlands) and the long post.
Leslie Kernisan, MD MPH says
Your situation sounds exceptionally complicated, plus you are 41 and dealing with specific issues that I don’t have particular expertise with. So I cannot comment on what medications might be reasonable for you to discuss with your health providers.
I will say that for some people who are younger or middle-aged, a more holistic “functional medicine” approach sometimes leads to good results. These practitioners endeavor to uncover the root causes of a person’s many symptoms, and then try to correct those, often through comprehensive lifestyle changes including dietary changes and other changes. You could look to see if any such providers are available in your country.
In particular, in the long run, non-pharmacological methods of managing sleep are much better and safer for the brain.
Re vitamin B12, I have an article here. For low-normal vitamin B12 levels, we often check methylmalonic acid; if that is higher than normal, that’s quite suggestive of inadequate vitamin B12. Good luck!
Danielle says
Thank you for the reply!
Nc says
Almost impossible to avoid all of these. That’s not a particularly helpful thing for me to say, so I will add that if you take a higher than recommended dose of promethazine, it can affect your memory very quickly. You’ll experience the usual effects, like drowsiness, but feel otherwise lucid, then lose your train of thought immediately. If this is not a normal thing for you, it’s quite alarming. What’s worse is an inability to backtrack to a point where you feel you might be able to latch on to the thought. It just goes.
Leslie Kernisan, MD MPH says
It’s true that it can be a challenge to avoid all of these, especially for people with complicated health situations. That said, in many cases there are alternative ways to treat or manage certain symptoms, which can allow for these medications to be reduced or stopped.
Eric Peterson says
holy s*** I’ve been using ibuprofen PM to sleep for years!! Been wondering what’s causing my worsening memory problems and morning depression lately. I can’t seem to process new information into long term memory at all. If I don’t write something down (like the paper towel that i’ll need to buy or the name of a new TV show I want to check out) I forget it within minutes 9 times of 10. Ouch!!
Leslie Kernisan, MD MPH says
Yes, ibuprofen PM contains diphenhydramine (aka Benadryl), which is quite anticholinergic. Hard to say how much that is contributing to the memory changes you’ve noticed, but generally it would be considered safest to avoid or minimize any medication that makes brain function worse. If you haven’t already done so, I would recommend bringing up your memory concerns to your healthcare providers, so that they can assess things further.
I have written a new article this year that explains the most common causes of memory and thinking changes:
Cognitive Impairment in Aging: 10 Common Causes & 10 Things the Doctor Should Check
Good luck!
Nina Sheldon says
I had chronic insomnia for most of my adult life. I also developed electrosensitivity. Research suggested turning off all electricity at night, which worked beautifully, and now I sleep like a child. However! During the years with insomnia, I began taking lorazepam and then added ambien. I’ve been taking both of these for years and am losing my memory. I assume that slowly cutting back is the right approach, but which of these should I try to cut back first? Apparently withdrawal from either is challenging. I seem to remember cutting back on lorazepam a bit, but trying to cut back on ambien was awful.
I’d welcome your response.
Leslie Kernisan, MD MPH says
Congrats on rethinking your medications, I think it’s good that you are trying to see if you can reduce your use of these sedatives.
Re which medication to start reducing first, hm…you could check with a pharmacist but I believe that lorazepam has a longer half life than ambien. In general it’s thought that withdrawal symptoms are a little less intense when it comes to medications with longer half-lives. So it might make sense to start by very slowly tapering down your Ambien, but I don’t know that there is an exact right answer to your question. I would definitely recommend you discuss this with your prescribing clinician.
I would also recommend that you seek help learning other ways to treat insomnia and to fall asleep without medication.
There is more on tapering lorazepam here: How You Can Help Someone Stop Ativan. Good luck!
Jim Palmer says
There is an abundance of data describing drug-drug interactions to avoid, but this data becomes sketchier beyond two-drug combinations. Three or more drugs at a time — there simply isn’t enough data (coupled, of course, with nutrition and lifestyle parameters — after all, the population of the US, let alone other countries, is heterogeneous enough to blur most patterns) to form reliable, consistent conclusions. One thing is for sure, however, and that is that polypharmacy is associated with increasing dementia in nursing homes. Whatever the cause (poor communication and record keeping, patient compliance, continuation of or additional prescribing of unnecessary medications, to name a few) it is abundantly clear that the more drugs people take as they get older, the greater their risk of harm, with diminishing beneficial returns.
A large part of the problem is the constant direct-to-consumer advertising of prescription drugs in the US — nowhere else in the world, other than New Zealand, is this permitted. It is an insidious practice, often couched in statements that demonstrate “risk reduction” (when said reduction is actually relative, rather than absolute risk, two parameters that are widely misused and misunderstood) as if piling on such and such a drug will be a cure-all.
What I would dearly love to see patients, their families/loved ones, and physicians alike adopt, is a mindset of “My goal is to reduce my medications as much as possible, and implement nutritional and lifestyle changes that will help me live a satisfying life for as long a time as I have.” We’re all going to die. Giving a 90-year old nursing home patient a statin and a BP drug in order to bring pharmacodynamic markers or measured values in line with ever-widening diagnostic/target goalposts, along with an antidepressant and a sleeping pill may not be doing them any good, but it’s likely to do them a fair amount of harm. Less medicine, more health! And it is up to doctors to ask patients what their goals are and to work with them in the most ultimately constructive way, instead of hiding behind the prescription pad so they can churn through sheer numbers.
Leslie Kernisan, MD MPH says
Agree that it would be good for more older adults to proactively try to reduce medication use to the minimum and manage health with non-drug treatments when possible. This is called deprescribing, I have more info here:
Deprescribing: How to Be on Less Medication for Healthier Aging
It is certainly trickier to check for interactions among multiple medications, but drug interaction checkers such as this one do allow people to enter in several medications at once.
Dawn says
Hi , I’m a 42 year old female whoms been suffering from Insomnia since my teen age years I used Benadryl & PM medications till 2007 then I was introduced to Ambien in 2006. The medication was believed to help me rest . Since 2007-2018 I switched between Restoril & Ambien. My cognitive memory has went on vacation aswell as I’m no longer able to retain short term memory events . I’ve went to a psychiatrist whom only gave me more drugs that I had to refuse due to the side effects . I want a good night sleep without drugs . What should I do ? Are their any medications which don’t impair the brain ? Giving me symptoms of Dementia ? Thank you Shannon
Leslie Kernisan, MD MPH says
Most medications that help people sleep do affect brain function.
Melatonin is a little different and seems to have much less impact on brain function, but it also works less well for sleep in younger adults, unless they have jet lag or something else affecting their circadian rhythm. (Melatonin seems to be more effective in helping older adults sleep, because often that circadian signal gets a little weaker with age, or due to neurodegeneration.)
Otherwise, in geriatrics we often try trazodone, since it seems safer than the other available options. That said, I don’t think we know how safe it would be to take this medication for decades to sleep.
The safest and best approach would be to use non-drug approaches to improve your sleep, such as cognitive-behavioral therapy for insomnia and also comprehensive approaches to manage stress and anxiety. This takes time and effort to implement, but works best in the long run. Of course, before pursuing this approach, I would recommend getting a comprehensive evaluation to check for other medical problems that might be affecting your sleep, such as sleep apnea and other potential causes. Good luck!
Guy J. Nowlan says
Dear Dr. Kernisan,
I just wanted to thank you for your efforts and dedication producing these valuable articles about gerontology. I discovered your website at the suggestion of some of my patients who were bringing precise and pertinent questions about the care of the elderly.
I find your website very informative, especially for a family physician like me, involved in post-graduate research.
Sincerely,
Guy J. Nowlan MD AAFP CFPC
Leslie Kernisan, MD MPH says
Hello Dr. Nowlan,
Thank you so much for this feedback! I’m delighted to be helpful and am always especially pleased when fellow clinicians find this work valuable.
Anthony Holt says
I’ve been taking Metoprolol for about 4 years now. I only take 12.5 mg every 24 hours. The only side effect I ‘ve been having is short-term memory loss. This is driving me crazy! Is there any other medication I can take that will not cause short-term memory loss but yet control my blood pressure? I’m 58….
Thanks
Anthony
Leslie Kernisan, MD MPH says
So, there certainly are other types of BP medication to consider, in fact metoprolol is not usually considered first-line for people who have garden-variety high blood pressure. (A beta-blocker type BP medication is mainly recommended for people with a past history of heart failure or coronary artery disease.) So, esp if you feel it’s giving you side-effects, you could ask your health provider about switching.
Your dose is also low, so another thing to consider is could you manage your BP adequately with lifestyle changes. I explain a framework to figuring out BP management here: 6 Steps to Better High Blood Pressure Treatment for Older Adults.
You don’t say whether the memory loss is new or has been present since you started metoprolol 4 years ago. It certainly could be related to medications, but many different things can affect brain function, so if you’ve noticed changes or have concerns, I would recommend discussing this with your health provider. There may be other health issues — many of which are treatable — that are affecting your memory. Good luck!