In keeping it real today, I wanted to share my top 5 medications that worsen dementia. This list is totally anecdotal based upon my experience and the frequency with which I see these medications used in clinical practice. Without further ado, here are my top 5 medications that worsen dementia!
Medications That Worsen Dementia – Top 5
Diphenhydramine (Benadryl) is the most common medication I see used. The primary reason for this is that it is highly promoted as a sleep aid and is available over the counter. Geriatric patients can have a lot of problems with insomnia, and this is a favorite go-to medication for our patients. It is a big problem due to its highly anticholinergic activity.
Oxybutynin and tolterodine are the two most commonly used urinary anticholinergics that I see in my practice. These agents can be helpful in reducing frequent urination and symptoms of urgency but can interfere with memory and cognition. If a urinary anticholinergic is indicated and the patient can afford it, it may be advisable to consider trospium which has a much lower likelihood of penetrating the central nervous system and contributing to confusion.
Both amitriptyline and nortriptyline are the two most commonly used TCA’s and can be used for various purposes. The most common situations I see these agents used for are patients with pain, insomnia, and mental health disorders. They are far from a first-line agent in the treatment of depression. In addition, I can’t ever see myself recommending that amitriptyline or nortriptyline for insomnia alone. This is especially true in our geriatric patients.
Cyclobenzaprine is primarily used for its muscle relaxant properties. Much like many of the other medications I’ve mentioned above, it has a good deal of anticholinergic activity. In addition, it is found in the Beers Criteria.
Antipsychotics have varying degrees of anticholinergic adverse effects. Clozapine, quetiapine, and olanzapine are generally considered more anticholinergic than many of the other atypical antipsychotics and because of this, I will put them in the list of medications that worsen dementia.
Here’s another post on dementia that you might find useful! What else would you add to this list?
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I would also like to add Topiramate used alone or in combination for epilepsy and also indicated for migraine prophylaxis. I recall several patients placed on this medication and expressed concern with memory problems or “not being able to think right”. Not sure about the other antiepileptic medications but I have definitely seen memory problems with topiramate. Has any others come across this adverse reaction with topiramate?
Good one Kirk! Thanks for sharing!