Drugs That Can Cause Dementia

Explore the complexities of reducing medication burdens in older adults, assessing over 170 drugs, dissecting guidelines, and highlighting the current lack of evidence on patient perspectives in this crucial health issue affecting millions globally.

A video report about the Making Of this post is available from Write in Stone, a research transparency platform. Also, be sure to check Publication Notes to learn more about the Zheln process.

How to Cite This Post?

Anticholinergic Deprescribing and Cognitive Decline Risk

Older adults commonly take multiple drugs at once. Many of them impact a person’s cognition, as is seen, for example, in a commonly misused over-the-counter drug against allergies, diphenhydramine. The combined impact of such medications (that are called anticholinergic) can increase the risk of dementia and lead to other poor health outcomes. An online calculator, which was created to estimate this combined impact, features a list of over 170 drugs that possess these properties. Accordingly, current guidelines for health care practitioners include the recommendation to try and reduce this burden when prescribing to older adults. In consequence, this topic is massively important and impacts over 500 million older people worldwide.

Little is known about the barriers and facilitators to successfully reducing this burden. A 2021 study identified two studies that asked a total of 48 health care practitioners about this, and they spoke about many barriers. Importantly, but not unusually, unfortunately, no studies were identified that actually asked the patients or their carers about this problem, how they feel about it, or how they think it could be changed.

Eventually, a new study, published in December 2023, reviewed the effectiveness of any measures aimed at the reduction of this kind of drug burden. Only three trials were identified, and all of them looked at medication review and changes by health care teams. However, the data reported were so poor that the researchers could draw no conclusions from it, despite the involvement of a total of almost 300 participants in these trials.

In summary, anticholinergic burden is a widely recognized medical problem. Despite that, no evidence is available as to the successes of anticholinergic burden reduction. 300 participants were involved in 3 trials to test that, but the trials did not provide good evidence. No studies have looked at how patients feel about the anticholinergic drug burden.

Written in Stone

Publication Notes

• The initial draft of this post was written by Claude 2 AI and then revised substantially before publication. In the interest of transparency, a full changelog is available.
• The opening summary was generated by prompting ChatGPT 3.5 to “write an engaging one-sentence description for this post” and then asking for “less drama.”
• The image for this post was generated with DALL·E 3 via Microsoft Bing Image Creator Preview by copying and pasting the post description as a prompt. Four images were generated, of which the most suitable was selected manually.
• Please refer to the video report for the methodology behind the research underpinning this post. The original Zheln methodology is available as a preprint.
• This publication is a piece of volunteer research and journalism. To express support, you can donate or reach out.

Citation

Zhelnov P. Drugs That Can Cause Dementia. Zheln. 2023 Dec 21;50(1):t2e13. URI: https://zheln.com/thread/2023/12/21/1/.

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