popular drugs increase the risk of cognitive impairment and Alzheimer's disease

Several popular drugs that are available by prescription and even over-the-counter can increase the risk of cognitive decline and dementia in older adults. And yet, you are hardly ever told.

Acetylcholine is an important neurotransmitter that is vital to memory and cognition. The severe reduction of acetylcholine is a hallmark of Alzheimer’s disease. And yet, several popular drugs reduce acetylcholine. This significant warning is seldom known or shared.

Some of the supposedly harmless drugs that lower acetylcholine include over-the-counter cough and cold medicines and sleep medicines, like Benadryl, Nytol, Theraflu and Triaminic. Tricyclic antidepressants, like amitriptyline, also lower acetylcholine.

Now a new American study has added to the frightening evidence. The study included 688 people: the average age was 74. All of them had healthy cognition and memories. A third of them were on drugs known to decrease acetylcholine.

The results were not encouraging. The people who were taking at least one of the acetylcholine lowering drugs were 47% more likely to develop mild cognitive impairment. Seniors with mild cognitive impairment may have trouble with memory and thinking that is not serious enough to cause the real problems of Alzheimer's disease; however, it can be a precursor to dementia.

And the news got worse when the researchers separated out the people who had biomarkers for Alzheimer’s disease: that is they were at increased risk for Alzheimer’s. For these people, the risk of developing mild cognitive impairment was a staggering 4 times greater than people without the biomarkers who were not taking the drugs. They were almost 2.5 times more likely to develop cognitive impairment than people without the biomarkers who were not taking the drugs.

And this group of drugs is not the only one that has been associated with increased risk of Alzheimer’s. A large study of elderly people found that the antianxiety drugs known as benzodiazepines increase the risk of Alzheimer’s. People who were on benzodiazepines long term had a 32.9% rate of Alzheimer’s compared to a rate of 27.8% in the control group. When they were on the benzodiazepines for 3-6 months, the risk went up by 32%; when they were on them for more than 6 months, the risk went up by 84%. Overall the risk of Alzheimer's went up by 43%-51% (BMJ 2014;349:g5205). A second study also found a 50% increased risk of Alzheimer’s for users of benzodiazepines (BMJ 2012;345:e6231).

And the list of popular drugs that increase your risk of dementia goes on. Drugs intended to cure ulcers also cause dementia (Curr Med Chem 2018;25(18):2166-2174). People who take a class of anti-ulcer drugs known as proton pump inhibitors (PPI) have a 44% increased risk of dementia (JAMA Neurol 2016;73(4):410-416). Another class of ulcer drugs known as histamine-2 receptor antagonists, like Pepcid, Zantac and Tagamet, have been linked to a 242% increase in the risk of cognitive impairment (J Am Geriatr Soc 2007;55(8):1248–1253).

Drugs are supposed to help people, not harm them. And, at least when they can harm, people should be warned. But few people know, and few people are warned, that several of the most popular drugs available-sometimes even over the counter—can damage memory and cognition and may even increase your risk of Alzheimer’s disease.

Neurology 2020;10.1212/WNL.0000000000010643.

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