Many people fear a diagnosis of Alzheimer’s more than cancer or heart disease. That’s because we have treatments for the two big killers, but virtually nothing to reverse the inevitable decline of dementia. Anyone who has ever cared for a person with Alzheimer’s disease knows how devastating it is for the patient as well as the family. That’s why aging baby boomers often worry about their memory and their mental sharpness.
When people have trouble recalling their Social Security number or a familiar person’s name at church, they may become frightened that dementia is around the corner. If a close relative starts to have memory problems, it is equally worrisome. This reader was worried about her mother.
What Happened to Mom?
Q. My mother was deteriorating before our eyes, and we were very worried about her. I was not happy with the physician she was seeing and took her to mine for a consultation.
My doctor took her off the bladder medicine Detrol and the blood pressure pill amlodipine immediately. Later, her cholesterol medication was changed as well.
Her blood pressure stayed in an acceptable range with some modification in her diet and adding a half hour of walking each day. Her brain fog (that mimicked dementia) lifted almost immediately. Her cholesterol also went to an acceptable level, and all the terrible side effects were gone. She is absolutely fine today. Please let your readers know that seniors may need special attention to their medications.
A. Drugs such as tolterodine (Detrol) that are often prescribed for bladder problems have anticholinergic activity. This can cause brain fog or memory problems in vulnerable people. We are pleased to learn that a reevaluation of your mother’s medications is helping her do so much better.
Medicines that Mess Up Memory
Alzheimer’s disease is a real risk associated with aging. But common medications can often contribute to confusion or forgetfulness.
Diphenhydramine (DPH) used to be found primarily in a highly sedating antihistamine called Benadryl. At one time, doctors prescribed it for allergy symptoms and warned their patients that it might make them drowsy. It has long been available over the counter.
If DPH were only being used as an antihistamine, it probably wouldn’t pose much of a risk for older people. But this compound is now found in many other medications, particularly in some that are marketed to the elderly. These are nighttime pain relievers such as Advil PM, Aleve PM and Tylenol PM.
The “PM” designation that suggests the drug will cause drowsiness nearly always indicates the presence of DPH. It is also found in a number of OTC sleep aids, such as Sominex, Unisom and ZzzQuil.
Anticholinergic Drugs Can Cause Confusion
Diphenhydramine belongs to a category of medications called anticholinergics. These are drugs that interfere with the activity of the essential brain neurotransmitter acetylcholine.
Drugs with anticholinergic action can cause a number of unpleasant side effects including dry mouth, constipation, blurred vision, drowsiness, difficult urination and decreased sweating. They can also cause confusion, memory problems and hallucinations.
The number of medicines that have anticholinergic activity is surprisingly high and often goes unrecognized. The most obvious examples include scopolamine, found in the motion sickness medicine Transderm Scop. It is also found in some medicines for irritable bowel syndrome (IBS) such as Donnatal. Other medicines that may be used for digestive tract spasms, atropine and hyoscyamine, also have strong anticholinergic activity.
Overactive Bladder, Incontinence & Brain Fog
Medicines that older people may take more frequently include drugs for urinary incontinence, euphemistically termed overactive bladder. These medications include oxybutynin (Ditropan, Oxytrol) and tolterodine (Detrol). Researchers have reported that oxybutynin has a high incidence of side effects, especially cognitive impairment in older people (International Journal of Clinical Practice, Sept. 2014).
We received this message from a concerned wife. She is worried about her husband’s memory problems:
“My 73-year-old husband is taking Detrol LA. I have noticed that he is often confused about what day it is, does not remember conversations and can no longer keep the check book balanced.”
Another person wrote:
“I’m 55 and experiencing poorer and poorer memory. I’ve had a bladder problem for 25 years. I’ve been on amitriptyline for a long time and Ditropan for eight months.”
It is worrisome that this person is taking two powerful anticholinergic medicines. It’s hardly any wonder she is having difficulty with memory. Amitriptyline (Elavil) is an antidepressant that is also prescribed for nerve pain or insomnia.
Combining anticholinergic medicines can lead to symptoms of dementia. We have a detailed list of anticholinergic drugs at this link. Consult it to protect yourself and your loved ones. You may also find our Guide to Drugs and Older People of value.