{"id":8707,"date":"2015-01-26T08:19:45","date_gmt":"2015-01-26T16:19:45","guid":{"rendered":"http:\/\/sop.washington.edu\/?p=8707"},"modified":"2025-12-04T11:31:26","modified_gmt":"2025-12-04T19:31:26","slug":"higher-dementia-risk-linked-use-common-drugs","status":"publish","type":"post","link":"https:\/\/staff.washington.edu\/twentzel\/wordpress\/higher-dementia-risk-linked-use-common-drugs\/","title":{"rendered":"Higher dementia risk linked to more use of common drugs"},"content":{"rendered":"
\"Image<\/a>
UW School of Pharmacy Professor Shelly Gray <\/figcaption><\/figure>\n

Dr. Shelly Gray et. al. found a persistent link between dementia and some medications in a University of Washington\/Group Health study published in JAMA Internal Medicine on January 26, 2015. The large study links a significantly increased risk for developing dementia, including Alzheimer\u2019s disease, to taking commonly used medications with anticholinergic effects at higher doses or for a longer time. Many older people take these medications, which include nonprescription diphenhydramine (Benadryl). JAMA Internal Medicine published the report, called \u201cCumulative Use of Strong Anticholinergic Medications and Incident Dementia.\u201d<\/p>\n

The study used more rigorous methods, longer follow-up (more than seven years), and better assessment of medication use via pharmacy records (including substantial nonprescription use) to confirm this previously reported link. It is the first study to show a dose response: linking more risk for developing dementia to higher use of anticholinergic medications. And it is also the first to suggest that dementia risk linked to anticholinergic medications may persist\u2014and may not be reversible even years after people stop taking these drugs.<\/p>\n

\u201cOlder adults should be aware that many medications\u2014including some available without a prescription, such as over-the-counter sleep aids\u2014have strong anticholinergic effects,\u201d said Shelly Gray, PharmD, MS, the first author of the report, which tracks nearly 3,500 Group Health seniors participating in the long-running Adult Changes in Thought (ACT), a joint Group Health\u2013University of Washington (UW) study funded by the National Institute on Aging. \u201cAnd they should tell their health care providers about all their over-the-counter use,\u201d she added.<\/p>\n

\u201cBut of course, no one should stop taking any therapy without consulting their health care provider,\u201d said Dr. Gray, who is a professor, the vice chair of curriculum and instruction, and director of the geriatric pharmacy program at the UW School of Pharmacy. \u201cHealth care providers should regularly review their older patients\u2019 drug regimens\u2014including over-the-counter medications\u2014to look for chances to use fewer anticholinergic medications at lower doses.\u201d<\/p>\n

For instance, the most commonly used medications in the study were tricyclic antidepressants like doxepin (Sinequan), first-generation antihistamines like chlorpheniramine (Chlor-Trimeton), and antimuscarinics for bladder control like oxybutynin (Ditropan). The study estimated that people taking at least 10 mg\/day of doxepin, 4 mg\/day of chlorpheniramine, or 5 mg\/day of oxybutynin for more than three years would be at greater risk for developing dementia. Dr. Gray said substitutes are available for the first two: a selective serotonin re-uptake inhibitor (SSRI) like citalopram (Celexa) or fluoxitene (Prozac) for depression and a second-generation antihistamine like loratadine (Claritin) for allergies. It\u2019s harder to find alternative medications for urinary incontinence, but some behavioral changes can reduce this problem.<\/p>\n

\u201cIf providers need to prescribe a medication with anticholinergic effects because it is the best therapy for their patient,\u201d Dr. Gray said, \u201cthey should use the lowest effective dose, monitor the therapy regularly to ensure it\u2019s working, and stop the therapy if it\u2019s ineffective.\u201d Anticholinergic effects happen because some medications block the neurotransmitter called acetylcholine in the brain and body, she explained. That can cause many side effects, including drowsiness, constipation, retaining urine, and dry mouth and eyes.<\/p>\n

\u201cWith detailed information on thousands of patients for many years, the ACT study is a living laboratory for exploring risk factors for conditions like dementia,\u201d said Dr. Gray\u2019s coauthor Eric B. Larson, MD, MPH. \u201cThis latest study is a prime example of that work and has important implications for people taking medications\u2014and for those prescribing medications for older patients.\u201d Dr. Larson is the ACT principal investigator, vice president for research at Group Health, and executive director of Group Health Research Institute (GHRI). He is also a clinical professor of medicine at the UW School of Medicine and of health services at the UW School of Public Health.<\/p>\n

Some ACT participants agree to have their brains autopsied after they die. That will make it possible to follow up this research by examining whether participants who took anticholinergic medications have more Alzheimer\u2019s-related pathology in their brains compared to nonusers.<\/p>\n

Drs. Gray and Larson\u2019s coauthors are Paul Crane, MD, MPH, an associate professor of medicine at the UW School of Medicine, adjunct associate professor of health services at the UW School of Public Health, and affiliate investigator at GHRI; Sascha Dublin, MD, PhD, a Group Health physician, GHRI associate investigator, and affiliate associate professor of epidemiology at the UW School of Public Health; Melissa L. Anderson, MS, and Onchee Yu, MS, senior biostatisticians, and Rod Walker, MS, biostatistician, at GHRI; Joseph T. Hanlon, PharmD, MS, a professor of medicine at the University of Pittsburgh; and Rebecca Hubbard, PhD, an associate Professor of Biostatistics at the Hospital of the University of Pennsylvania, who did this work while on staff at GHRI.<\/p>\n

This work was supported by National Institute on Aging NIH Grants U01AG00678 (Dr. Larson), R01AG 027017, R01AG037451, P30AG024827, T32 AG021885, K07AG033174 (Dr. Hanlon), and R03AG042930 (Dr. Dublin) and by the Branta Foundation (Dr. Dublin).<\/p>\n

For a list of medications highlighted in the study, please view this story\u00a0from the AARP Bulletin<\/a>.<\/p>\n

# # #<\/p>\n

University of Washington School of Pharmacy<\/h3>\n

The UW School of Pharmacy is committed to educating the next generation of leaders in pharmacy, pharmaceutical research, and health care\u2014while seeking to ensure the safe, rational, and cost-effective use of medicines. Founded in 1894, the UW School of Pharmacy is ranked #3 in the world according to Shanghai Jiao Tong University. Follow the School of Pharmacy on Facebook<\/a> or Twitter<\/a>.<\/p>\n

UW Medicine<\/h3>\n

UW Medicine is part of the University of Washington. Its mission is to improve the health of the public by advancing medical knowledge, providing patient care, and training the next generation of physicians and other health professionals. Its system includes Harborview Medical Center, Northwest Hospital & Medical Center, Valley Medical Center, UW Medical Center, UW Neighborhood Clinics, UW Physicians, UW School of Medicine and Airlift Northwest. UW Medicine is affiliated with Seattle Children\u2019s, Fred Hutchinson Cancer Research Center, the Veteran\u2019s Affairs Healthcare System in Seattle, and the Boise VA Medical Center. It shares in the ownership and governance of the Seattle Cancer Care Alliance and Children\u2019s University Medical Group.<\/p>\n

Group Health Research Institute<\/h3>\n

Group Health Research Institute does practical research that helps people like you and your family stay healthy. The Institute is the research arm of Seattle-based\u00a0Group Health Cooperative<\/a>, a consumer-governed, nonprofit health care system. Founded in 1947, Group Health Cooperative coordinates health care and coverage. Group Health Research Institute changed its name from Group Health Center for Health Studies in 2009. The Institute has conducted nonproprietary public-interest research on preventing, diagnosing, and treating major health problems since 1983. Government and private research grants provide its main funding. Follow Group Health research on\u00a0Facebook<\/a>,\u00a0Twitter, or\u00a0YouTube<\/a>.<\/p>\n","protected":false},"excerpt":{"rendered":"

Dr. Shelly Gray et. al. found a persistent link between dementia and some medications in a University of Washington\/Group Health study published in JAMA Internal Medicine on January 26, 2015. 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