Drugs To Avoid In Patients With Dementia

Elderly people with dementia often tolerate drugs less favorably than healthy older adults. Reasons for this include:

An increased sensitivity to certain side effects
Difficulty with adhering to drug regimens
Decreased ability to recognize and report adverse events

Elderly people with dementia are also more prone than healthy elderly persons to develop drug-induced cognitive impairment.¹ Medications with strong anticholinergic (AC) side effects, such as sedating antihistamines, are well-known for causing acute cognitive impairment in people with dementia.^1-3

What Are Anticholinergic (AC) Drugs Used For?

Dizziness (including vertigo and motion sickness-related symptoms)
Gastrointestinal disorders (e.g., peptic ulcers, diarrhea, pyloro spasm, diverticulitis, ulcerative colitis, nausea, and vomiting)
Genitourinary disorders (e.g., cystitis, urethritis, and prostatitis)
Insomnia, although usually only on a short-term basis
Respiratory disorders (e.g., asthma, chronic bronchitis, and chronic obstructive pulmonary disease
[COPD])
Sinus bradycardia due to a hypersensitive vagus nerve

Anticholinergic-like effects, such as urinary retention and dry mouth, have also been identified in drugs not typically associated with major AC side effects, eg. narcotics and benzodiazepines.³These drugs are also important causes of acute confusional states. When used appropriately, the CIs (donepezil [Aricept], rivastigmine [Exelon], and galantamine [Razadyne, Reminyl]) may slow the decline of cognitive and functional impairment in people with dementia. In order to achieve the best therapeutic effect, CIs should ideally not be used in combination with ACs.^1,2

Factors That Determine If A Patient Will Develop Cognitive Impairment When Exposed To AC Drugs

Total AC load (determined by number of AC drugs and dosage)
Baseline cognitive function
Individual patient’s bodily functions like renal and liver function

What Does Jura Care Village Say About Anticholinergic Drugs?

Evidence suggests that the use of Anticholinergic drugs plays a key role in the development of Alzheimer’s disease. Sadly, there are countless care facilities throughout the world who rely on AC drugs too easily and too early, predominantly used as a sedative for their patients/residents. Not only this, but AC drugs are prescribed by medical professionals too easily. That said, there is a place for drug therapy however we would like to emphasize this always to be the last resort. “The first step is always to look at the method of care.” Says Marlene van Niekerk, MD of the Jura Care Village. “How can I care better? What can I try? What will work? These are the questions one should ask when someone with a form of Dementia is difficult to care for.”

When selecting drug therapy for patients with dementia, the use of AC medications should be avoided, or at least limited to medications within a therapeutic class that have the least AC adverse effects. The following table summarizes medications associated with causing worsening cognitive function in patients with dementia. Therapeutic alternatives are included when possible.