Risk For Dementia May Increase With Long-Term Use of Anticholinergics, Study Suggests (nytimes.com) 53
An anonymous reader quotes a report from The New York Times: A new study suggests that people who take a class of common medicines called anticholinergic drugs for several years may be more likely to develop dementia as they age (Warning: source may be paywalled; alternative source). Anticholinergic drugs include the antipsychotic clozapine; the bladder drug darifenacin (marketed as Enablex); the anti-nausea drug scopolamine; the bronchodilatoripratropium; the muscle relaxant tizanidine; antihistamines such as diphenhydramine (brand names include Benadryl), and antidepressants such as paroxetine (brand names include Paxil). These medications work by blocking a chemical called acetylcholine, which acts as a neurotransmitter and is involved in many nervous system functions including muscle movements, heart rate, the widening of blood vessels, respiratory functions and muscle contractions in the stomach during digestion.
The research, conducted by Carol Coupland, a professor of medical statistics in primary care at the University of Nottingham in England, and colleagues, evaluated anticholinergic drugs prescribed to nearly 285,000 people age 55 and older. About 59,000 of them had a diagnosis of dementia. The study found a 50 percent increased risk of dementia among people who used a strong anticholinergic drug daily for about three years within that 10-year period. The association was stronger for antidepressants, bladder drugs, antipsychotics and epilepsy medications, the study said. Researchers did not find any increased risk of dementia with antihistamines, bronchodilators, muscle relaxants or medications for stomach spasms or heart arrhythmias. The link between anticholinergic drugs was stronger for people diagnosed with dementia before they turned 80 and in people with vascular dementia compared to people with Alzheimer's disease, the authors reported.
The research, conducted by Carol Coupland, a professor of medical statistics in primary care at the University of Nottingham in England, and colleagues, evaluated anticholinergic drugs prescribed to nearly 285,000 people age 55 and older. About 59,000 of them had a diagnosis of dementia. The study found a 50 percent increased risk of dementia among people who used a strong anticholinergic drug daily for about three years within that 10-year period. The association was stronger for antidepressants, bladder drugs, antipsychotics and epilepsy medications, the study said. Researchers did not find any increased risk of dementia with antihistamines, bronchodilators, muscle relaxants or medications for stomach spasms or heart arrhythmias. The link between anticholinergic drugs was stronger for people diagnosed with dementia before they turned 80 and in people with vascular dementia compared to people with Alzheimer's disease, the authors reported.
Let me guess... (Score:1)
Re:Let me guess... (Score:4, Insightful)
Guess what, figuring out all ill effects of a substance require a sample size equal of the population and unlimited time. Do you really want to allocate the resources for such a test? How many can you pay for?
Drug testing is not a black-and-white issue, and not everything is a conspiracy.
Re: (Score:2)
Oh no, we're the poorest country in the world!
Re: Let me guess... (Score:1)
It says antihistamines don't cause it, even though they list Benadryl... which is an antihistamine.
Re: (Score:3)
Read more closely, it just says Benadryl is an anticholinergic, they do not claim that all anticholinergic are associated with increased dementia risk.
Weeeelllll... a (probably) mangled report of a (probably) mangled study. Stay tuned for the next episode.
Re: (Score:3)
Read more closely, it just says Benadryl is an anticholinergic, they do not claim that all anticholinergic are associated with increased dementia risk.
Weeeelllll... a (probably) mangled report of a (probably) mangled study. Stay tuned for the next episode.
Actually the report specifically calls out antihistamines, such as Benadryl, as not associated with increased dementia risk. That is, for the very heaviest users of antihistamines (using more than 1095 total daily doses), the risk is 14% higher relative to the control group, but that estimate has a 95% confidence interval from -2% to +34% relative to control. For less than 1095 daily doses, the risk is 2-3% above control, which is basically noise compared to the confidence interval. So, basically low to
Re: (Score:2)
Also, one very important aspect of the report that seems to be ignored in the news articles is the impact of dosage. The report presents results only in terms of cumulative dosage over 1 to 11 years. It's not entirely clear how the findings would change if the dosage rate were considered independently or in conjunction with the cumulative dosage.
So, for the patients who see elevated dementia risk with >1095 daily doses, are the risks similar if the doses are spread over 3 years (i.e., a dose every day)
Re: (Score:2)
It says antihistamines don't cause it, even though they list Benadryl... which is an antihistamine.
The person who wrote the report has allergies.
Re: (Score:2)
Okay, from now on, we'll add an extra 10 years to the approval time for drugs, that was the time frame of the study. Last I checked (which was years ago), a drug started out with several thousand possible versions and to whittle them down to 1 or 2 that might be efficacious took about (surprisingly) 10 years. It also cost about a $1 Billion. I presume that price has gone up. The time has probably gone up as well because the low hanging fruit has been plucked.
Now let's multiply that by the thousands of drugs
Re: (Score:2)
Diphenhydramine is an old drug. I've read somewhere else that if it was actually up for approval now it wouldn't get approved as an OTC medicine.
A similar 1st generation antihistamine is hydroxyzine, which is prescription only. IMHO, it's basically a stronger version of diphenhydramine in its effects.
Never saw that comping did you (Score:4, Interesting)
From wikipedia:
An anticholinergic agent is a substance that blocks the neurotransmitter acetylcholine in the central and the peripheral nervous system. These agents inhibit parasympathetic nerve impulses by selectively blocking the binding of the neurotransmitter acetylcholine to its receptor in nerve cells.
So a drug that specifically fudges the chemistry for nerve signal transmission just somehow screws up brain function down the road. Who knew.
Wonderful (Score:4, Interesting)
Great, so the drugs the doctor prescribed to help with the anxiety I've been having mostly about the complications of aging may turn out to be responsible for one of the worst complications of aging...
Re: (Score:3)
From the summary, it's not that simple. They specifically said, e.g., that it wasn't strongly related to Alzheimer's, and more strongly related to vascular dementia...which is considerably rarer.
Re: (Score:2)
While the discovery and attribution of the cause may be new, I don't believe the drugs are new. And I don't think (no real evidence) that they're as commonly used as they were a couple of decades ago.
Now my estimate of the use level of those drugs is only based on stories I happened to read in either the news or the popular science publications, so it's not reliable. But it's a reasonable first cut at a guess.
Of course, statistics don't apply to individual cases. But the summary didn't say how much more
Association to Drugs or to Symptoms? (Score:5, Interesting)
The association was stronger for antidepressants, bladder drugs, antipsychotics and epilepsy medications, the study said. Researchers did not find any increased risk of dementia with antihistamines, bronchodilators, muscle relaxants or medications for stomach spasms or heart arrhythmias.
So drugs not associated with dementia were all used to treat physical symptoms. And with the exception of the bladder drug, all of the drugs associated with dementia were used to treat mental symptoms.
Could it partly be that the (prescription of) drugs and (later) dementia have a common cause, instead of one causing the other?
Wait, Scopolomine is an anti-nausea drug? (Score:2)
I thought it was most famous as a mind-control drug [drugs.com].
It even got namechecked in an Archer episode...
Re: (Score:3)
Yes, Scopolomine is used for both anti-nausea and anti-vertigo.
I've been prescribed it for the former and on it daily for the last 4-5 years now, and I've never experienced anything even close to described in those documentaries or news stories.
So far the worst side effect from it are vision problems, some that have been pretty scary for sure.
But my memory is no worse off than before, no zombie mind control watching myself do whatever I'm told. In fact if anything I'm told I'm even more belligerent with ag
Re: (Score:2)
I thought it was most famous as a mind-control drug [drugs.com].
It even got namechecked in an Archer episode...
In low, controlled doses it's an antiemetic, but in larger doses it's a powerful sedative and was originally used as a aesthetic (not any more as it had some nasty side effects). It's not a truth or mind control drug, that is the invention of popular media (like Archer), someone who has been drugged with it will behave similar to someone who's very, very drunk or on a high dose of benzodiazepines. Any information gleaned from someone would be highly suspect. Its gained a reputation due to foreigners being d
Pesticide Abuse is Worse (Score:1)
Pesticide (ab)use in our society is much, much, worse.
Yes, pesticides are anticholinergic.
Re:Pesticide Abuse is Worse (Score:4, Insightful)
"Yes, pesticides are anticholinergic"
Try to be accurate with your language. No, all [implied] pesticides are not anticholinergic. To wit, pyrethroids and nicotinoids are not. In fact, treatment for poisoning by these compounds are, wait for it, anticholinergics.
Correlation ain't causation (Score:2)
Perhaps it's one of the many conditions that require these drugs that cause dementia and not the proposed cure.
Re: (Score:2)
Perhaps it's one of the many conditions that require these drugs that cause dementia and not the proposed cure.
This! Some of these drugs are treating problems that are indicative of significant psycho-medical issues.
"We're taking you off of your anti-psychotic medicine Bill, because you might get dementia."
The biggest risk factor (Score:2)
Hmmmmm (Score:4, Funny)
As I get older I'm starting to believe in the hereafter.
I walk into a room and think, "What the hell was I here after?"
Benadryl (Score:1)
Don’t be so smart, Spock, you botched the acetylcholine test!
Firsthand Experience (Score:2)
I've seen the results of this up close and personal with my father. My Mom passed away back in 2011, and my father, a retired pharmacist, went into a slow decline. Dad continued taking a lot of over the counter cold/allergy meds, as he had most of his life for bad allergies. After a few years, Dad was frequently on another planet - actively hallucinating, calling 911 constantly, wandering, etc. On several occasions, Dad was told to stop taking any anticholinergic medications, and given a long list of things