Common Remedies Can Damage Older Brains

Older patients who take popular remedies for sleep, pain, and allergies may be harming their brains.

New neuroimaging research out of Indiana University offers visual proof that anticholinergic drugs can cause cognitive impairment in mature patients.That finding was backed up by cognitive tests.

“The use of anticholinergic medication was associated with increased brain atrophy and dysfunction and clinical decline,” the researchers said, “Use of anticholinergic medication among older adults should likely be discouraged if alternative therapies are available.”

The mean age of study participants was 73.3 years.

Prescribed for asthma, incontinence, gastroenteritis and muscle spasms because of their effect on the neurotransmitter acetylcholine, anticholinergics are also found in antihistamines, sleep aids and over- the-counter pain relievers like Nytol, Excedrin PM and Benadryl.

Brain scans and cognitive tests showed physical and physiological manifestations of diminished brain function in participants who took either prescription or OTC anticholinergics during the course of the study.

Funded by the Department of Defense and the Alzheimer’s Disease Neuroimaging Initiative Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults by Shannon L. Risacher, PhD, assistant professor of radiology and imaging sciences at Indiana University and colleagues appears in JAMA Neurology.

Earlier research associates this class of drug with an increase in signs of dementia for elderly patients. This investigation is the first to ground the finding in neuroimaging.

Looking at data on 451 cognitively normal older adults comprising 402 Alzheimer Disease Neuroimaging Initiative (ADNI) participants and 49 from the Indiana Memory and Aging Study (IMAS) the team assessed cognition through results of memory and executive function testing. Positron emissions tests (PET) gauged glucose metabolism (a biomarker for brain activity). Magnetic resonance imaging (MRI) represented brain atrophy.

The cognitive tests revealed that patients taking anticholinergic drugs performed worse than older adults not taking the drugs on short-term memory and some tests of executive function, which cover a range of activities such as verbal reasoning, planning, and problem solving.

Cognitive scores, mean fludeoxyglucose F 18 standardized uptake value ratio, and brain atrophy measures from structural magnetic resonance imaging were compared between the group of survey participants taking anticholinergics (AC+) participants not taking the drugs (AC-).

The 52 AC+ participants (mean [SD] age, 73.3 [6.6] years) from the ADNI showed lower mean scores on Weschler Memory Scale—Revised Logical Memory Immediate Recall (raw mean scores: 13.27 for AC⁺ participants and 14.16 for AC⁻ participants; P = .04) and the Trail Making Test Part B (raw mean scores: 97.85 seconds for AC⁺ participants and 82.61 seconds for AC⁻ participants; P = .04) and a lower executive function composite score (raw mean scores: 0.58 for AC⁺ participants and 0.78 for AC⁻ participants; P = .04) than the 350 AC⁻ participants (mean [SD] age, 73.3 [5.8] years) from the ADNI. Reduced total cortical volume and temporal lobe cortical thickness and greater lateral ventricle and inferior lateral ventricle volumes were seen in the AC⁺ participants relative to the AC⁻ participants.

“These findings provide us with a much better understanding of how this class of drugs may act upon the brain in ways that might raise the risk of cognitive impairment and dementia,” said Risacher.