For insight on the connections between patient medication and cognitive function, Dr. Reza Hosseini Ghomi, BrainCheck’s Chief Medical Officer, shares personal clinical experience from his practice.
One of the first places I start when I receive a new referral at my memory clinic is the medication list. So often, it’s here that I find a culprit of cognitive impairment — even if a patient has an underlying neurodegenerative disorder.
The majority of the patients I see, and many of those you see, take more than one medication.
And I would estimate that more than half of the patients I see are taking one or more medications that I am able to eliminate and demonstrate cognitive benefit by doing so.
I have had some stunning improvements in people diagnosed with various dementias. I’ve even seen functioning return in some patients that allowed them to drive again and to not get lost, to maintain their finances and do their taxes.
It’s incredibly rewarding to see such a benefit in someone who may think the loss of cognitive abilities is permanent.
Medications with Increased Dementia Risk
One easy class of medications to identify and avoid in anyone over 65 (or younger if any cognitive impairment is measurable) is anticholinergics.
A number of studies have demonstrated the connection between the use of anticholinergic drugs and increased risk of dementia. A recent, large case-control study of almost 60,000 patients found people who took a daily dose of a strong anticholinergic for 1–11 years prior had a 49% increased risk of dementia. Notably, physicians had prescribed at least one of 56 anticholinergic drugs to more than half of subjects. This certainly provides enough evidence to help our patients avoid these medications and improve their cognitive health.
These medications can be very useful and work quickly for myriad problems, ranging from allergies to overactive bladder to insomnia. And younger patients can tolerate anticholinergics with minimal side effects.
However, I’m not sure I have ever come across a situation where an anticholinergic medication was justified in someone with cognitive impairment. The benefits simply never outweigh the risks. There are enough “brain safe” alternative medications, it is generally a smooth process discontinuing or replacing these culprits.
Avoiding Medications that Impact Cognitive Function
Since I work primarily with the geriatric population, it’s easier for me to identify medications with potential cognitive side effects. That can be a much harder task for physicians switching from different populations throughout the day.
Additionally, identifying these medications presents challenges. Often, you can find anticholinergics hidden in the ingredient lists of over-the-counter medications. One common scenario I come across is patients who are taking a “PM” medication. Almost invariably, these medications have some form of diphenhydramine, a potent anticholinergic.
Another thing to keep in mind: even if a patient has been on a medication for many years, their bodies are not the same as when the medication was started. Their organs have aged, and their metabolism has changed and very likely slowed. A medication they may be very attached to may need to be tapered and stopped. Or, the physician could replace it with a safer alternative in order to spare their cognition.
The BEERS criteria published by the American Geriatrics Society can be a helpful resource. It features anticholinergic medications prominently on their list of potentially inappropriate medications in elderly.
Assess and Track Cognitive Function with BrainCheck
When removing these medications, significant cognitive improvement can be demonstrated in both daily activities and cognitive testing.
For patients with cognitive impairment or cognitive concerns, BrainCheck’s digital cognitive assessment platform can allow physicians to set a baseline and see how cognitive function changes over time.
I often perform cognitive testing before and after changes to prescriptions to measure the impact. And BrainCheck gives me the tools I need to assess the effects with objective, test-retest reliability.