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Higher Dementia Risk Linked to Some Common Medications

Discussion in 'Other Health News and Research' started by Wally, Jan 26, 2015.

  1. Wally

    Wally Senior Member

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    http://www.sciencedaily.com/releases/2015/01/150126124721.htm


    Click here to read more of this news release - http://www.sciencedaily.com/releases/2015/01/150126124721.htm
     
  2. anciendaze

    anciendaze Senior Member

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    What they are not saying is that people who constantly take drugs have preclinical conditions which are not being treated, or are being treated with drugs alleged to relieve symptoms temporarily. Instead of blaming patients for "false illness beliefs", why not blame doctors who don't take such conditions seriously?
     
  3. rebar

    rebar Senior Member

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    thank you Wally, I have been relying on Benadryl for itching and flushing of the skin of my face. I read science
    daily but had not come across this. this study is deeply troubling.
     
  4. CFS_for_19_years

    CFS_for_19_years Hoarder of biscuits

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    USA
    I had a doctor who decided that he would not let me continue taking cyclobenzaprine (Flexeril) for its anticholinergic effects. With severe back spasms, I switched to doxepin - a tricyclic antidepressant that is also anticholinergic. Like that made any sense at all!! On top of that, taking doxepin caused me to become hypomanic, something I've had to treat at various times by stopping all antidepressants altogether or face being put on a mood stabilizer, drugs that have their own slew of adverse effects.

    Anyway, for anyone who's interested, here's a list of anticholinergic drugs:
    prescribersletter.therapeuticresearch.com/pl/ArticleDD.aspx?nidchk=1&cs=&s=PRL&pt=2&segment=3860&dd=271223
     
  5. Arc

    Arc

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    Tricyclics taken by ME patients are anticholinergics linked to dementia

    Sorry to arrive so late to this thread, but I'm new here and I'd like to discuss this research a bit because I think a lot of ME patients are prescribed tricyclic "antidepressants" at low doses to help with sleep and/or pain - and these are anticholinergics with a link to dementia. This applies even at low doses, if you are taking them long-term (as I do).

    I don't want to scaremonger, but I think it's worth alerting folk to the possible risks so they can make their own call (I'm trying to come off tricyclics myself).

    This study is, sadly, pretty robust as far as I can tell (I'm fairly research-literate, and I couldn't find any good criticisms of it by others either).

    If anyone can point out where this study falls down so that I can safely disregard the findings, I will be eternally grateful.

    Cumulative Use of Strong Anticholinergics and Incident Dementia
    A Prospective Cohort Study

    Unfortunately I can't post any links til my 6th post, so links to follow later.

    The highest risk group, with the highest doses, have a 50% increased risk of dementia compared with the no risk group. And the problem with an increased risk is that dementia is already fairly common. Taking daily tricyclic such as amitriptyline, even at the lowest possible daily dose, would put you in the highest risk category if you'd taken it for at least three years.

    The main reason to disregard this study is that is was on a fairly old population: minimum age of 65 to join the trial, average age of 74. However, given that the biology of dementia is known to start decades before any symptoms appear, the process may well be underway in people in their fifties and maybe even forties, so you might not want to take medications that potentially make things worse.
     
  6. Arc

    Arc

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    My fifth post, so I can finally post links (think this is protection against spammers so fair enough)
     
  7. Arc

    Arc

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    ABSTRACT (with links to relevant sections)
    ABSTRACT | INTRODUCTION | METHODS | RESULTS | DISCUSSION | CONCLUSIONS | ARTICLE INFORMATION | REFERENCES
    Importance Many medications have anticholinergic effects. In general, anticholinergic-induced cognitive impairment is considered reversible on discontinuation of anticholinergic therapy. However, a few studies suggest that anticholinergics may be associated with an increased risk for dementia.

    Objective To examine whether cumulative anticholinergic use is associated with a higher risk for incident dementia.

    Design, Setting, and Participants Prospective population-based cohort study using data from the Adult Changes in Thought study in Group Health, an integrated health care delivery system in Seattle, Washington. We included 3434 participants 65 years or older with no dementia at study entry. Initial recruitment occurred from 1994 through 1996 and from 2000 through 2003. Beginning in 2004, continuous replacement for deaths occurred. All participants were followed up every 2 years. Data through September 30, 2012, were included in these analyses.

    Exposures Computerized pharmacy dispensing data were used to ascertain cumulative anticholinergic exposure, which was defined as the total standardized daily doses (TSDDs) dispensed in the past 10 years. The most recent 12 months of use was excluded to avoid use related to prodromal symptoms. Cumulative exposure was updated as participants were followed up over time.

    Main Outcomes and Measures Incident dementia and Alzheimer disease using standard diagnostic criteria. Statistical analysis used Cox proportional hazards regression models adjusted for demographic characteristics, health behaviors, and health status, including comorbidities.

    Results The most common anticholinergic classes used were tricyclic antidepressants, first-generation antihistamines, and bladder antimuscarinics. During a mean follow-up of 7.3 years, 797 participants (23.2%) developed dementia (637 of these [79.9%] developed Alzheimer disease). A 10-year cumulative dose-response relationship was observed for dementia and Alzheimer disease (test for trend, P < .001). For dementia, adjusted hazard ratios for cumulative anticholinergic use compared with nonuse were 0.92 (95% CI, 0.74-1.16) for TSDDs of 1 to 90; 1.19 (95% CI, 0.94-1.51) for TSDDs of 91 to 365; 1.23 (95% CI, 0.94-1.62) for TSDDs of 366 to 1095; and 1.54 (95% CI, 1.21-1.96) for TSDDs greater than 1095. A similar pattern of results was noted for Alzheimer disease. Results were robust in secondary, sensitivity, and post hoc analyses.

    Conclusions and Relevance Higher cumulative anticholinergic use is associated with an increased risk for dementia. Efforts to increase awareness among health care professionals and older adults about this potential medication-related risk are important to minimize anticholinergic use over time.

    HOW TO SEE IF YOUR MEDICATION IS INCLUDED AND WHAT YOUR TSDD WOULD BE
    The key thing here is the TSDD, or total standardised daily dose. The paper includes a supplement
    http://archinte.jamanetwork.com/data/Journals/INTEMED/932778/IOI140138supp1_prod.pdf
    which lists medications and the 'minimum effective dose' for each, which counts as the "standardised daily dose", or SDD. Total SDD is over ten years.

    You can check that supplement to see if it includes your own medication. As an example, amitriptyline, which many people (me included) take to help with sleep, has a SDD of 10mg.

    So for someone taking 20mg (=2 SDDs) every night for ten years:
    TSDD = 2 x 365 days x 10 years = 7,330.

    That would put it in the highest risk category (TSDD > 1,095), with an increased risk of dementia of 1.5x.
     
    Last edited: Aug 12, 2016
    Little Bluestem likes this.
  8. Arc

    Arc

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    One issue with this study is that problems with depression and sleep can be early signs of undiagnosed dementia, and people might wind up taking tricyclics like amitriptyline to treat the early depression/sleep problems due to dementia. That could explain the link between tricylics and dementia.

    However, to tackle this problem, the authors ignored any medication taken in the 12 months before diagnosis. They also did a later analysis where they ignored any medication taken 2 years before diagnosis, and the link with dementia was much the same.

    Finally, they split the anticholinergics into medications for depression (and sleep) like amitriptyline, and the rest, to see if those anticholinergics that wouldn't be taken due to early signs of dementia had a lower risk. But it didn't seem to matter what the anticholinergic was, they were all linked to dementia.

    Hoping to see some rebuttals of all this, or maybe you've all moved on, or don't share my paranoia :)
     
  9. rebar

    rebar Senior Member

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    Thanks for the update Arc. I didn't see seroquel, (quetiapine) and have seen it listed as anticholinergic.
     
    Last edited: Aug 12, 2016
    Arc likes this.

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