Dementia Related Post

The Mad Book Chapter 16

Checking your Meds!

Only 8 minutes … so click the Play Button above and listen along while you drink your coffee!

Medications are so obviously beneficial in treating infections, cancer, high blood pressure,
pain, fever, inflammation, just to name a few. Yet, no medication is free of side effects. And when the side effects interfere with attention, memory, language, executive function, or other cognitive abilities, and the medication you’re taking is not considered, an examining clinician might incorrectly suspect the presence of progressive dementia.

Many medications have been shown to cause or are suspected of causing cognitive symptoms.

I’ve added a table below showing the medication I’m talking about.

Here are some of the most recognised drugs that affect our cognitive abilities and mimic neural decline.

The first is Anticholinergics. Don’t panic; as in all medicine, the words used are mind-blowing and can be frightening in themselves, but let me clarify this. Anticholinergics are a broad group of drugs that act on the neurotransmitter acetylcholine. Acetylcholine is a neurotransmitter. Neurotransmitters are chemicals in the brain that are responsible for messages passing from one brain cell to another.

Acetylcholine declines with age, as do all things, and as a result, the passage of messages between brain cells is affected. If there is enough impact, then the signs and symptoms of neural decline are evident.

Many Anticholinergics drugs are used for a wide variety of conditions, from helping with insomnia, irritable bowel syndrome, muscle cramps and spasms, urinary, and even some gastrointestinal problems. That’s everything to do with where food goes in to coming out, to you and me.

The list is wide-ranging. Even some antidepressants, cardiac medications, antispasmodics, antivertigo medications, and antiparkinsonian medications have anticholinergic effects.

Unfortunately, there seems to be this balancing act between the benefits and the consequences. You and the medical team have to be aware of the signs and symptoms and possible connections to the medication you are taking.

The effects of anticholinergic medications on the brain include confusion, memory disturbance, agitation, the decline in cognitive abilities and even delirium. We are so aware of these that knowing the difference between medication-induced problems or other causes is paramount.

Then there are the Benzodiazepines, a class of medications used to treat anxiety or insomnia, comprise another group that has been linked with cognitive difficulties. A commonly prescribed and illegally used drug. Benzo, Benies, Downers are common street names! Although these medications are indeed a blessing for some individuals immobilised by anxiety, their use can be accompanied by sedation and mental slowing. A recent study even suggested that prolonged use of benzodiazepines might be a risk factor for later dementia.

Corticosteroids, I think these are better known as steroids and used for lots of conditions such as asthma, hay fever, allergic rhinitis, eczema, inflammation of the joints, muscles and tendons, lupus, Crohn’s and even MS, the list goes on. These drugs can be life-saving when prescribed appropriately, which I’m sure many would support.

However, the anticholinergic impacts have to be monitored and vital for the patient’s mental health!

Pain-relieving medications, particularly opioids, are important and valuable when used correctly. This is Morphine and Heroin, a so-called recreational drug we hear so much about. It is strange if the doctor said he wanted to prescribe Morphine or Heroin, which would you choose?

Their harmful effects on short-term memory have been investigated and recognised. Pain relief is a necessity, of course, and proper use of pain-relievers is important. Their cognitive effects, like the other medications here, are often reversible after the medicines are stopped. It’s stopping that is hard, especially as they are addictive! The longer you are on them, the greater the impact and the harder to recover.

Chemotherapeutic drugs; this is a hard one, is there another option?
Cognitive changes associated with anticancer chemotherapeutic agents is now a well-documented condition that affects some, though not all, patients treated with these medications. “Chemo brain” affects attention, working memory, and executive function and sometimes leaves lasting changes.

The Statins, a very widely used drug. The cholesterol-lowering statins, more recently, have been suspected of creating mental slowing and memory problems in some people, but a lot more research into this is needed. It seems the current consensus is that it is not a common complication, but it is a possible complication.

In the last part, I will talk about the ageing brain and getting old. This is something that is always stated as not impacting neural decline, so-called dementia. I’ve stated my case and thoughts throughout the last chapters. It is worth noting that the effects of ageing on drug action and metabolism help explain how medications that seem safer in younger people can interfere with thinking in older individuals. The ageing liver and kidney are less efficient in reducing toxic drug effects. The ageing brain has less protective cognitive reserve; a younger brain has more remaining brain cells! And, very importantly, the multiple prescribed medications typical for older adults offer many opportunities for drug interactions that can amplify individual medications’ adverse effects. The harmful effects of medications are exacerbated too, when alcohol is thrown into the mix! Even a moderate amount of alcohol use can add to the side effects of medications. Do Not Drink Alcohol is possibly on all prescription drugs, but do we listen? I doubt it!

A human trait; the young think they are invincible! We’ve all been there, but we only take note when it hits home to you or someone we hold dear!

Often it is difficult to disentangle the possible sources of cognitive changes in an older person taking multiple medications for medical conditions that in their own right can affect mental functioning. If you believe that drugs are causing memory loss or affecting other cognitive functions, discuss this with your health care providers. They should help determine whether medications interfere with cognitive functioning by carefully re-examining your symptoms’ history to understand the most likely causes of the symptoms, reducing or eliminating specific medications, or replacing necessary medications with alternate drugs that possess different properties.

This sounds obvious, and you think it would be a normal part of your regular review, wouldn’t you? Do you have a routine check?

I’ll leave you with what was my daily intake of prescription medication.

I’m now on a campaign to remove as many as possible. This was instigated by my son and my daughter following the moment I decided I no longer wanted to be here and actively started collecting tablets to end it! And not the caring profession!

This is certainly something we didn’t do lightly. I thought the medical profession was doing right by me, but we were wrong in my case!

I’m not saying that everyone should come off their medication. Still, I am saying always question the time you’ve been taking them, the possible side effects on your cognitive abilities and the alternatives!

The list below is not a complete list:

My daily medication list:

Aspirin 75mg 1 daily Heart
Atorvastatin 80mg 1 daily Heart
Bisoprolol 5mg 1 daily Beta Blocker Heart
Candesartan 16mg 1 daily Heart
Bendroflumethiazide 2.5mg I daily Diuretic Heart
Glyceryl Trinitrate 500micrograms when required Heart
Betahistine 16mg 1 – 3 times daily Meniere’s
Cinnarizine 15mg 2- 3 times daily Meniere’s
Lamotrigine 150mg 1 twice daily Anti Epileptic
Levetiracetam 1.5g 1 twice daily Anti Epileptic
Pregabalin 100mg 1 twice daily Nerve Pain. Anxiety & Epilepsy
Mirtazapine 45mg I daily at night Antidepressant
Lorazepam 1mg 1 twice daily Bensodiazepine. Anxiety
Risperidone 0.5mg 1 daily at night Anti psychotic
Venlafaxine 75mg I daily Antidepressant SNRIs
Omeprazole 20mg 1 daily Acid Reduction in stomach
Salbutamol 100micrograms every 4 hours Asthma
Salmeterol 50micrograms 1 twice daily Asthma
Cleaning module 100micrograms 2 twice daily Asthma

Below the drugs I have come off over the last two years:

X Donepezil 10mg 1 daily at night Dementia
X Citalipram 40mg 1 daily at night SSRI Anti Depressant
X Gabapentin 300mg 1 – 3 times daily Nerve Pain & Epilepsy
X Oramorph 10mg/5ml when required Severe Pain
X Zomorph 40mg 1 twice daily Severe Pain

1 reply »

  1. You’ve certainly made me stop and think about how when we’re prescribed various drugs for certain conditions that in most cases, like myself, we never question it and just accept that it’s going to be the right thing to take. I wouldn’t imagine for example that something taken for IBS could affect your cognitive ability! Maybe I need to pay more attention to the warnings/ info given with medication.

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