Medications That Worsen Dementia and Increase Dementia Risk


What Medications Make Dementia Worse?

Many of us are familiar with what dementia is, or at the very least, have heard the term. The medical model of dementia perceives it as a symptom of various brain diseases, characterised by losing the ability to memorise or remember things. In severe cases, there are significant behavioural changes and the patient may be unable to perform the simplest of the tasks.

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However, dementia can be cured with the correct medication, and several medication classes for dementia as well as medical interventions for dementia exist.

While dementia medication in the UK works to treat dementia, and medication aids for dementia and are widely prescribed as medications to treat dementia, some routinely used non-dementia medications can aggravate dementia if not taken carefully. We will here discuss how commonly used medications affect individuals with dementia. Before we move forward, a little introduction to dementia is important.

How does dementia progress?

Dementia is not a disease itself but rather a symptom of multiple diseases, of which the most common is Alzheimer's disease.

The brain is a complex structure that is responsible for regulating almost every single function of the body. Physical changes such as the buildup of proteins, low supply of red blood cells or alpha-synuclein (a protein implicated in Parkinson’s disease) clumps in the brain structure can impair cognitive function, leading to the development and progression of dementia. However, you can slow down dementia with medication.

Stages of Dementia:

Dementia is a progressive disease, which means once developed, it never stops advancing and continues to escalate in severity until the patient's death. Research is currently underway to discover dementia prevention medication.

The symptoms and stages of dementia are:

  • Mild: This is the initial stage of the disease and is not life-threatening. It involves forgetting stuff related to everyday life. Medication for the early stages of dementia is available.
  • Moderate: As the disease progresses, the condition of the patient also worsens. The patient may suffer from a continuous state of confusion, and the memory deteriorates even more. Medical management of dementia can greatly improve the quality of life.
  • Severe: It is the last stage of dementia, characterised by an inability to perform everyday tasks, and communicate effectively. Patients usually need assistive care at this stage. Medication for late-stage dementia includes rivastigmine, and dementia medication donepezil, to name a few.

Medications Implicated in the Worsening of Dementia Symptoms:

Now that you have a sound understanding of what dementia is, let's move forward to what medications can cause dementia. Here's a list of medications that may cause dementia:

1. Anticholinergic Drugs:

The first on our list are anticholinergic drugs, one of many medications that can cause dementia.

Mechanism of Action: This class of drugs is responsible for inhibiting the production/secretion of Acetylcholine, which is a neurotransmitter playing a significant role in regulating the tasks performed by the parasympathetic nervous system, such as learning, muscle movement, etc. The link between anticholinergic medications and dementia is well-established.

Alzheimer's disease and dementia are also caused due to the deficiency of Acetylcholine. Administering drugs that further reduce the concentration of the neurotransmitter in the brain can be hazardous and may cause the disease to progress more rapidly. The adverse effects of acetylcholine medications in dementia are well-documented.

Commonly Used Anticholinergic Medications: It is important to know about the drugs classified as anticholinergic so they can be readily recognised if an individual exhibits behaviour that indicates dementia. A list of anticholinergic-medication that causes dementia is:

  • Tri-cyclic Anti-depressants
  • Sedative Anti-Histamines
  • Muscle Relaxants
  • Over-the-counter drugs
  • Parkinson’s medication

Can Parkinson’s medicine cause dementia? – The answer is yes, Levodopa and Carbidopa are medications for Parkinson’s causing dementia.

Many medicines used in daily life are anticholinergics. Therefore, if you have a dementia history in the family, it is important to be careful.

Alternative Medication: Alternatives to the drugs mentioned above are commonly available but not prescribed until the concern is forwarded to the related medical authorities. Therefore, it is important to discuss your dementia medical history, and any other, with the doctor beforehand.

2. Benzodiazepines:

Benzodiazepines, commonly known as tranquillisers, are used to treat depression, anxiety, muscle disorders, and other associated diseases. Anticholinergic and benzodiazepine medication use and risk of incident dementia are commonly addressed concerns.

Mechanism of Action: This class of drugs boosts the effect of GABA receptors (inhibitory receptors) within the brain, producing a sedative and hypnotic effect.

Is anxiety medication linked to dementia? — Numerous research studies have been conducted all across the globe to determine whether benzodiazepines are linked to the progression of dementia and more than half of these studies gave positive results, thereby proving the relation.

There are two types of benzodiazepines:

  • Long-Acting Benzodiazepines
  • Short-Acting Benzodiazepines

The research concluded that long-acting benzodiazepines were more likely to increase the risk of dementia than short-acting benzodiazepines. Furthermore, the duration of use also played a significant role; individuals using benzodiazepines for more than three months had a 30–32% chance of developing dementia, whereas more than six months of use increased the risk to almost 84%.

Benzodiazepines medications:

  • Alprazolam — Also known as Xanax
  • Diazepam — Also known as Valium
  • Clonazepam — Also known as Klonopin
  • Lorazepam — Also known as Atinav

To sum it up, dementia and anxiety medication do not go well together.

Alternative medication: Benzodiazepines are widely used for insomnia and anxiety, and while it may be hard to find alternatives as effective, options are available. For example, anxiety can be treated by certain SSRIs, or cognitive/behavioural therapy can induce sleep without the help of any medication. Therefore, it is important to find the best anti-anxiety medication for the elderly with dementia that suits the individual needs.

3. Steroids:

Steroids are a class of drugs used to treat inflammatory diseases.

Mechanism of Action: Steroids exert their effect by inhibiting certain inflammatory enzymes, which ultimately reduces inflammation.

Dementia is not always an irreversible medical condition. Reversible dementia, a condition that can be reversed once the triggering factor is removed, is caused by steroids. It causes insomnia and confusion.

Commonly Used Steroids:

  • Prednisone
  • Dexamethasone
  • Hydrocortisone
  • Betamethasone

Research has shown that individuals using Prednisone in high doses or for prolonged periods were more susceptible to the development of dementia as compared to other steroidal medications. However, any corticosteroid used in high-doses has the potential to exacerbate dementia.

Alternative Medication: Several alternatives are available to Prednisone with a similar effect but reduced side effects. It is strictly advised not to change or stop the medicine abruptly without consulting the doctor.

4. Antipsychotics:

It is a class of drugs used to treat psychosis and manage behavioural difficulties in the elderly.

Mechanism of action: These drugs exert an inhibitory action on the dopaminergic pathways in the brain.

Why is antipsychotic medication not good for dementia patients? — In dementia patients, antipsychotics have the potential to increase the fatality risk. If there's a need for these drugs, they should be used at a very minimal dose.

Antipsychotic Medication:

They are divided into two generations:

First-generation drugs:

  • Haloperidol

Second-generation drugs:

  • Risperidone
  • Olanzapine
  • Quetiapine

Alternative medication: Alternatives are available and should be considered if the health of the patient deteriorates. Behavioural therapy is also an effective option. Certain SSRIs may help as well.

5. Beta-Blockers:

Beta-blockers are a class of drugs used to treat high blood pressure, in the prevention of a heart attack, and to manage heart rhythm. It is one out of the many medications contraindicated in dementia

The use of beta-blockers is linked to the risk of developing vascular dementia and may decrease the quality of life of individuals who already have dementia. Therefore, dementia and high blood pressure medication are linked.

Commonly Used Beta-Blockers:

  • Atenolol
  • Acebutolol
  • Metoprolol
  • Propranolol

What to do if a family member is using these medications?

Many medicines mentioned above are a part of the regime for a lot of elderly or mid-aged patients.

Now that we know that anticholinergic and benzodiazepines medication use and incident dementia are related, it is important not to panic if you notice a medicine in a family member's routine, which comes under the class of medications that can worsen dementia. Often, individuals abruptly stop their medications, leading to other problems that can turn into a disease in the long term. Always consult the doctor and put forward your concerns before you stop taking prescribed medicine. Ask them to review the prescription and list alternatives. Moreover, medical tests for dementia can help with diagnosis.

In the case of over-the-counter medications, usually, anticholinergics can be stopped without the consultation of a doctor. However, using alternatives is a must because therapy cannot be terminated. For example, over-the-counter sleeping pills are strongly anticholinergic, and anticholinergic medications and dementia are linked. The therapy can be concluded if the patient exhibits symptoms of dementia or the condition declines. However, other therapeutic measures must be employed.

How do I know my loved one has medication-induced dementia?

Early diagnosis of the disease can help manage it properly and slow down the progression. A person developing medication-induced dementia will show symptoms that can be examined to confirm the diagnosis. The medical symptoms of dementia include:

  • The patient struggles to concentrate for a long period
  • Behavioural changes
  • Struggling to remember daily life information
  • State of confusion

If the symptoms are overlooked and the medication is not stopped, the condition may worsen with time. As dementia is a progressive disease, it never stops advancing and continues to aggravate. Different medicines are used to treat the symptoms such as dementia medication donepezil is used to manage the state of confusion.

It is of utmost importance to get yourself checked frequently if dementia runs in the family or you are of age. Communicate to the doctor about common medications that may cause dementia and act accordingly.

Can dementia be prevented?

Dementia affects approximately 50 million people every year across the globe. The risk of developing dementia increases with age; people over 65 years of age are more likely to develop symptoms. While certain lifestyles changes may help reduce the risk, they cannot be eliminated. Apart from age and other factors, genetics play a vital role. If a family has a history of developing dementia at old age, the individual is at a higher risk and must take all necessary precautions. A list of medications linked to dementia have already been discussed and should be avoided in such circumstances. While a cure for dementia is yet to be discovered, certain medications to slow the progression of dementia are available in the market.

Dementia is a complex disease, and even though not enough research is available on the prevention of this disease, certain factors can help you minimise the chances and reduce the overall risk.

1- Physical Activity:

Physical activity can help reduce the chances of dementia to a considerable extent. Not only does it help in the prevention of dementia, but it also helps improve the overall circulation and mental well-being. It is important to find exercises that work for you and incorporate them into daily life. 25–30 minutes of physical activity every day is considered helpful.

2- Mental Exercises:

An excellent way to keep dementia out of sight is to use your brain. Keeping the brain active minimises the risk of dementia. Do activities that challenge your brain and increase activity such as:

  • Puzzles
  • Boardgames
  • Reading
  • Languages

3- Healthy Diet:

What you eat plays a significant role in determining brain health. Maintaining a healthy diet rich in vitamins, minerals, and other nutrients may help reduce the risk of dementia. The diet should consist of:

  • Proteins
  • Unsaturated healthy fats (Omega-3-FA)
  • and Vitamins

4- Avoid smoking and alcohol:

Some people wonder if they can drink with dementia medication. Smoking and drinking alcohol may multiply the chances of developing dementia. Therefore, if you have a habit of consuming alcohol or are involved in chain-smoking, seek rehabilitation therapy and reduce the consumption.

How to take care of dementia patients?

Taking care of individuals who have dementia is not an easy task and may require assistance. The following options are available:

Assisted living facility: Some people may be unable to take care of their family members with dementia due to their busy schedules or inability to understand and cater to their needs. Many assisted living facilities and care homes are operational all across the UK where the patients are taken well care of, and all their needs are fulfilled accordingly.

At-home carer: Some people wish to take care of their elderly parents by themselves. In such cases, it is important to have vast knowledge about dementia and how it progresses, the behavioural changes that may occur over time, the medications and the dos and don'ts. . In the last stages of the disease, the patient may require 24/7 care which may be hard to manage along with work. In such cases, an at-home carer may be required. Understanding the medical model of care for dementia is essential. In these testing times of COVID-19 pandemic, live-in care may be preferred.

Frequently Asked Questions (FAQs):

Are there medications to slow dementia?

While it may not be possible to eliminate the disease, certain medications can slow down the procession.

Are there medications to help treat dementia?

Yes, there are several medicines prescribed to dementia patients to help with symptoms and progression.

Is Alzheimer's a type of dementia?

Yes, Alzheimer's is characterised by the loss of memory and, in severe cases, an inability of motor functions. It is a common type of dementia.

Can I stop medications linked to dementia if I see any symptoms?

It is strictly prohibited to stop medications by yourself. Consulting a doctor is a must and cannot be skipped as they may help you find alternatives.

Are all over the counter drugs linked to dementia?

Over-the-counter drugs that come under the class of anticholinergics are linked to dementia and can be stopped without the doctor’s consultation.

How to convince dementia patient to take medication?

Counsel them properly and talk to them about how important it is for their health.

Is dementia a medical or mental illness?

Dementia cannot be described as a mental illness, but rather a disorder of the brain.

Does taking medication for dementia help prolong life?

Taking medication for dementia helps slow down the progression of the disease which may ultimately prolong life to some extent.

What are the top 5 dementia medications?

  1. Donepezil
  2. Galantamine
  3. Rivastigmine
  4. Tacrine
  5. Aducanumab

Are there any side effects of medication for dementia?

The patients may occasionally experience nausea, vomiting and muscle pain etc.

How does dementia medication work?

Dementia medications are focused on blocking the breakdown of acetylcholine, an important neurotransmitter.

Are bladder control medications and dementia-related?

The majority of the bladder control medications are anticholinergic which is why they are on the list of medications linked to dementia.

Is there a link between blood pressure medication and dementia?

Beta-blockers are known for their ability to induce dementia.

How quickly does dementia progress without medication?

The progression of the disease may vary from person to person. There’s not a single timeline to indicate the progression.

Can you drink with dementia medication?

Drinking with dementia medication is not recommended as it may interfere with the anti-dementia medication.

What is the best anti-anxiety medication for dementia patients?

It is important not to self-medicate and consult your doctor to find the medication that best suits your needs.

Dr Jamie Wilson
Founder and Chief Medical Officer at Hometouch
Dr Jamie Wilson is hometouch’s founder and Chief Medical Officer. Jamie’s creation of hometouch was inspired by his work as a dementia psychiatrist in the NHS, and he has written about healthcare issues in The Times and the Evening Standard. Jamie has a MBBS from the University of Leeds and has spent a decade in the NHS, working as a Psychiatric Registrar and Memory Specialist at Imperial College Hospital.