The onset of memory lapses and cognition problems are often chalked up as inevitable aspects of aging. But for many people, it’s their medications that are causing some memory and thinking issues. The side effects of drugs ranging from cold medicines to anti-anxiety medications often list complications like memory lapses, fuzzy thinking and difficulty concentrating. And yet, patients tend to look elsewhere for the cause of these changes.
“This is a vastly underappreciated problem, and it’s particularly a problem for older people,” says Anthony Weiner, MD, director of Outpatient Geriatric Psychiatry at Massachusetts General Hospital. He adds that some of the blame for individuals not understanding the cognition and memory side effects that can coincide with their medicines must be shared by the patients themselves, as well as theirÊphysicians.
Medication and Memory
The list of common drugs that can interfere with thinking skills, concentration and memory include both prescription and over-the-counter (OTC) drugs. Some of the most common medications that can affect brain function include:
- Anticholinergics to treat urinary incontinence, tremor caused by Parkinson’s disease (PD).
- Anticonvulsants to treat epileptic seizures.
- Antihistamines to treat allergies, colds.
- Benzodiazepines to treat anxiety, seizures.
- Beta blockers to treat high blood pressure, arrhythmias.
- Nonbenzodiazepine sedative hypnotics to treat insomnia, sleep disorders.
- Opioids to treat severe pain.
- Selective serotonin reuptake inhibitors (SSRIs) and serotonin norepinephrine reuptake inhibitors (SNRIs), to treat depressive and anxiety disorders, as well as pain.
- Tricyclic antidepressants to treat depression, anxiety disorders, some hormone disorders.
Keep in mind that many people take these medications and report no cognition-related side effects. Of that list, Dr. Weiner notes that anticholinergics, benzodiazepines, and opioids are among the biggest concerns, though the side effects of any medication or supplement should be understood and respected.
You may wonder how an anticholinergic, a drug commonly prescribed to treat urinary incontinence, can affect brain function. When the ingredients in a drug enter the bloodstream, they circulate throughout the bodyÑincluding through the brain.
Anticholinergics interfere with the action of acetylcholine, which is a neurotransmitter involved with involuntary muscle movement. It helps keep the bladder from contracting and releasing urine involuntarily. Unfortunately, Dr. Weiner notes, acetylcholine also is essential for normal brain function. Blocking acetylcholine activity can lead to sedation and fall risk.
Benzodiazepines are widely used anti-anxiety medications, and may also be prescribed for muscle spasms and to help prevent seizures. Some common examples include alprazolam (Xanax), diazepam (Valium), and lorazepam (Ativan). Benzodiazepines enhance the effects of a neurotransmitter called gamma-aminobutyric (GABA), providing sedative, anti-anxiety, and muscle-relaxing benefits.
“These have to be prescribed with caution at any age,” Dr. Weiner explains. “But you have to be especially cautious with older adults, as benzodiazepines can lead to unsteady walking and falls.”
Opiods are powerful pain relievers that have garnered considerable attention in recent years for their addictive properties and their role in many fatal and near-fatal drug overdoses. Prescription opioids include oxycodone (OxyContin) and hydrocodone (Vicodin) among others. They are often prescribed after surgery or for people struggling with chronic pain. And while these narcotic drugs can be effective at easing pain, they can also lead to confusion, depression and other serious side effects.
And because of those complications, doctors should be very cautious in prescribing opioids, with an eye toward limiting refills and guiding patients toward non-medication treatments.
When self-treating with OTC medications for a cold, insomnia, allergies and other health challenges, you should always be aware of all potential side effects as well as interactions with any medications you are currently taking. If you’re unsure about the safety of a particular medication, ask your doctor or a pharmacist.
The key is checking for the active ingredients on a medication’s label. You may think you’re taking a simple pain reliever for a headache, but there may be an ingredient that can cause you problems.
For example, medications labeled as “PM” should be taken with caution, understanding that they may cause thinking troubles. That’s because medications such as Tylenol PM, Advil PM, and Alka-Seltzer PM contain diphenhydramine (Benadryl), an antihistamine that can help relieve itching and other allergy and cold symptoms. Diphenhydramine is an antihistamine that can cause drowsiness, Dr. Weiner explains, so in addition to making you tired and possibly clouding your thinking, it can also put older adults especially at a higher risk for falls andÊinjury.
When Changes Occur
If you or a loved one notice a change in your memory or cognition or even your mood or behavior, consider whether you have recently started a new medication. Did you start taking a stronger dosage or start taking the medication more frequently?
If you suspect that your medication is the culprit, Dr. Weiner suggests you tell a responsible adult in your close circle—a spouse, an adult child, someone who will look out for you if the side effects get too serious. You should also tell the prescribing doctor and your primary care physician.
“It can’t be one or the other,” Dr. Weiner says. “All your doctors need to know. You have to keep up the process to make sure everyone is informed.”
The solution may be changing the dose, the frequency or the type of medication. Be willing to work with your doctor and pay close attention to any side effects.
The result, hopefully, will be a medication that effectively and safely treats the condition for which it was intended without affecting your memory and cognition.