A study in Seattle released this week suggested that the high use of anticholinergic medications by people over the age of 65 may be linked to developing dementia. This associated is not clear and all agree that the relationship is not just a cause and effect. It was simply noted that in a group of patients, 65 years and older, who developed dementia over seven years, there was a slightly higher use of these types of medications. Certainly most who develop dementia have not used these medications.
Anticholinergics are very common and most use of them come from over-the-counter sleep aids and allergy medications such as Benadryl®. Most “night-time” versions of cold medications have these in them. There are a few prescription medications that we use in headache treatment are in this class as well and that includes amitriptyline, nortriptyline and mirtazepine.
We have always used these medications in caution in the older population. What does this mean for those taking these medications? If you are younger than 60 and the medications are helping your headaches, then you should stay on them as there is no evidence that taking these medications will make you more prone to dementia. There is much stronger evidence that untreated headaches ruins someone’s life and can lead to brain injury. If these medications are really helping you, the odds are in your favor that you are better off staying on them. If you are over 60, it is worth discussing if there is a reasonable alternative to taking these medications.
I am doing this post in the middle of a series that I’m doing on pharmacophobia, the irrational fear of medications. It is now part of pop culture in the U. S., especially in the Pacific Northwest that all medications are dangerous, evil and unnatural. I’m afraid that those who go around scaring people will use this kind of data to prove their point, while they don’t even have a clue what the data really means. This study does not conclude that these types of medications cause dementia and should not be taken that way.
I will remind readers that a study a couple of years ago showed that people who do take beta blockers, a medication that we use far more common than the anticholinergics, may actually reduce your risk of developing dementia and previous studies have shown that they help to prevent heart attacks.
We will keep you posted if there is any new information to pass along.
J. Michael Jones, MPAS-C