senior woman with her adult daughter

Americans are justifiably concerned about Alzheimer’s disease and other forms of dementia. Aging baby boomers are hitting the age where they could be vulnerable to cognitive decline. Anticholinergic drugs like amitriptyline have been especially problematic. A German study published in PLOS One (online, Feb. 10, 2017) reported that drugs with the most anticholinergic activity like amitriptyline (Elavil) and quetiapine (Seroquel) were linked to greater mental decline. That is why this question from a reader is so relevant.

Is Amitriptyline Contributing to Dementia?

Q. My wife, 76, has been taking amitriptyline since 2013. Just last week, the results of a PET scan confirmed she has dementia. Her neurologist said the amitriptyline should not have been much of a factor, but I wonder.

A. Amitriptyline is an old-fashioned antidepressant. It is included on the Beers List of drugs that should be avoided or used with extra caution for people over 65 (Pharmacist’s Letter, Nov. 2015).

Anticholinergic drugs like amitriptyline can contribute to confusion, memory problems and cognitive impairment. There are literally dozens of drugs that have anticholinergic activity. Many people do not realize that several of the drugs they may be taking could have an impact on brain function. Side effects of such medicines can include:

Anticholinergic Symptoms:

  • Dry mouth and nose
  • Constipation
  • Confusion, memory problems
  • Blurred vision and other visual difficulties
  • Difficulty urinating
  • Dizziness, unsteadiness

We have compiled a list of anticholinergic drugs so people can discuss this issue with their physicians. No one should ever stop taking a medication without a conversation with the health professional who prescribe it.

Where Can I Find A List of Anticholinergic Drugs?

Stories from Readers:

One of the strongest anticholinergic drugs is scopolamine. This reader shared a sad scopolamine story:

“My wife used a scopolamine patch for three weeks on a vacation to prevent motion sickness which it did. Unfortunately it also caused memory loss.

“That was over four years ago and memory loss continues to this day. We have met with three neurologists and they have done brain scans but offered no remedies.

“Prior to the day the scopolamine patch was attached my wife had absolutely no memory problems or symptoms of dementia or Alzheimer’s and her life style and family history indicated no danger signs.”

Eileen in Alberta is caught between the proverbial rock and a hard place:

“I have been on amitriptyline for my fibromyalgia. Although I have tried other meds, Elavil is the only one that works.

“Once I had a photographic memory, but now I am suffering memory loss and I can’t remember from second to second. I have also been having dizziness.

“I have been on this medication for twenty years. When I tried getting off the med, after two weeks I could hardly move and had severe pain every where. I don’t know what to do.”

Abigail in NV says:

“Please add loperamide (Imodium) and Lomotil (diphenoxylate plus atropine ) to your list of anticholinergic drugs. And add to the symptoms poor balance (risk of falling).

“I have experienced cognitive difficulties from these drugs and, when I take them, I have difficulty walking a straight line and balancing while going up and down steps. The cognitive problems mimic dementia. The balance problems can be dangerous.”

Thanks for the tip, Abigail. Those drugs are indeed anticholinergic and we have added them to the list.

So you and others can learn more about this problem and other drugs that may be inappropriate for senior citizens, we are sending you our Guide to Drugs and Older People.

Anyone who would like a copy, please send $3 in check or money order with a long (no. 10) stamped (70 cents), self-addressed envelope:

  • Graedons’ People’s Pharmacy, No. O-85
  • P. O. Box 52027
  • Durham, NC 27717-2027

It can also be downloaded for $2 from the website: www.peoplespharmacy.com.

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  1. Ann
    michigan
    Reply

    I also took amitriptyline 10 mg for 8 years for chronic daily headaches. It worked great! My mother and 3 aunts were in nursing homes for dementia, in their 80’s. So as soon as I found out the concerns about the drug causing dementia I went off it. I’m now on cymbalta after trying effexor for 3 months, and it didn’t help at all. So far cymbalta is not helping, I’m 63 and do not know what to do. I am currently seeing a neurologist.

  2. Julie
    IN
    Reply

    I hope everyone understands that finding a link (coalation) to a disease really means nothing. And no one has found evidence that anticholinergic drugs cause dementia. For example, my 49 yo sister has been diagnosed with early onset Alzheimers dementia. There was a study (talked about on tv) that reported a “link” between diet pop and dementia. Of course my sister drinks diet Dr Pepper – when I looked at the study, it also showed a link between sugar sweetened soda also.

    Anticholinergic drugs are used more in older people, because of age related illnesses. I could do a study of dementia patients and show a link between aspirin, fiber cereal, denture paste or peanut butter. That doesn’t mean anything of those things CAUSE dementia. Can anticholinergics cause drowsiness, short term memory loss, fuzzy brain when you take them, absolutely but alcohol, marijuanna and sleep deprivation from chronic pain do too.

    The one thing we do know is that people with dementia have lower acetecholine levels in their brains, aricept and namenda increase acetylcholine. Anticholinergics work by decreasing overactive nerve responses to acetylcholine. They don’t cause increased TAU levels or plaques and tangles in the brain.

  3. Deanna
    Wisconsin
    Reply

    I took a tricyclic antidepressant for 20 years. I have concentration and memory loss problems which have been getting worse. My doctor will give me a memory test in about 6 months.
    I no longer am taking that medication, and have not taken it for 10 years.

  4. J. David A
    Springfield, MO, USA
    Reply

    Interesting in your lists is the absence of captopril and lisinopril which are not anticipated anticholinergics. The additive anticholinergic effects of the pharma cocktail prescribed by an uncoordinated “team” are also problematic.

    Two lists would help patients. The top anticholinergics in the 100 most frequently prescribed and OTC drugs. The top anticholinergic drug combinations would be the second list.

    The anticholinergic hypothesis has been overblown somewhat and has people afraid of taking 10 mg of Doxepin for hives – the sleep disturbance from the disease also a dementia risk.

  5. Rita
    Reply

    I have also been diagnosed with dementia from these drugs. I took generic Ditropan for approximately 15 years. No one gave me any warning. I now have Alzheimer’s dementia & they only expect it to get worse. I know it is from these drugs. They are in a number of things that I have taken over the years and no-one tells anybody about this danger. I know what Alzheimer’s does. My husband lived with this for 10 years before he died.
    Any help or advice ? I fee like my life is over………..

  6. CARLIE
    Columbia, SC
    Reply

    I didn’t see Armour Thyroid on the Beers List. I’m 68. I prefer Armour Thyroid over Synthroid because it has both T3 & T4 and because I feel much better taking T3 & T4. However, I am continually receiving warnings against Armour Thyroid for people over 65. Please, WHY??

    Thanks.

    Carlie

  7. HelenM
    Modesto
    Reply

    First, I was given gabapentin for my neuropathy, then Lyrica. Add protonix, though I will admit it was splendid to be able to sleep without a Tums in my mouth. I had a kidney removed (cancer) 2009, and traced my cognitive decline to living with only one kidney, when I was 71 years old. Now…….my thoughts are going elsewhere.

    For a brief time, I took amitriptyline, and it threw me into a terrible depression. One night I found I was just unable to take that pill; the next morning I felt better. So I dropped it.

    Now, doctors are learning that drugs they once thought were wonder pills may have dire consequences. For myself, I would rather have a shorter life than one with dementia.

  8. Cheri
    WA
    Reply

    I also took amitriptyline for fibromyalgia for several years. Because my mother had dementia, and I had noticed more difficulty finding the right word or remembering a name, as well as a general sense of slower, fuzzier thinking, I stopped taking it as soon as I became aware of the anticholinergic/dementia association. Although I do have to cope with more pain, I am encouraged to do so because I can remember those words and names, and can think clearly again. It’s definitely worth it.

  9. Mary
    WA
    Reply

    This is my experience with dementia symptoms due to Lorazapam.

    When my mother was in her late 80’s, she was prescribed Lorazapam for anxiety by her GP in Chicago. She eventually developed severe symptoms of dementia to the point where she no longer recognized my brother and thought there were two of my fathers living with her. She was then diagnosed with Alzheimer’s by two specialists, and at that point, I moved my parents to Seattle near me so I could help with their care. When I took my mother to a geriatric specialist in Seattle, he weaned her off Lorazapam, and all her mental faculties returned! She lived into her mid-90’s with her mental faculties still in tact!

  10. Dr. Judith
    Kfar Saba, Israel
    Reply

    Post hoc, ergo propter hoc?
    And in English, correlation is not causation.

    • Cheri
      Reply

      Correlation is not causation, but it IS correlation. It’s too bad that research into that correlation doesn’t pay off unless there’s a big, money-producing drug at the end of it.

      When we talk about the monetary cost of dementia, we always think of the people who are paying it–the families who care for elderly parents, or who spend their own retirement savings to pay for assisted living and uninsured, unproven medications in the so far futile hope that they will help. But that money goes somewhere.

    • J. David A
      Springfield, MO, USA
      Reply

      Ativan/Lorezepam has a long half-life in older people – and kills REM sleep like all tranquilizers. No REM sleep = dementia. Topamax, Mevacor, Benadryl are some of the other sneaky ones which kill REM sleep.

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