What Causes Alzheimer's Disease - Drug Use

Hi, this is Teri.  I am a 3rd generation Alzheimer’s Survivor and a co-caregiver of a parent who is surviving and thriving despite having Alzheimer’s Disease.

This week we will talk about medications that can create and cause memory loss. Over an extended period, memory loss might develop into Alzheimer’s Disease.

To be clear, I AM NOT A MEDICAL DOCTOR. While I worked in a pharmacy for the last 4+ years with two of the most amazing mentors, I am not a Doctor of Pharmacy either. I am not a nurse. I am not a medical assistant. I am an individual who can take complex information and recompose it so nonmedical individuals can understand it enough to know if this affects them or their loved ones.  With this knowledge, they can schedule an appointment and talk to their doctor.  Also, I can make suggestions for some supplemental nutritional solutions to help.

Most of us know some of the things that can impair memory, including alcohol and drug abuse, heavy cigarette smoking, head injuries, stroke, sleep deprivation, severe stress, vitamin B12 deficiency, and depression.  Over the last few years, we have added illnesses like Covid-19 to that list.

What many people don’t realize is that a number of commonly prescribed drugs and over the counter (OTC) medications also can interfere with memory. The medications I am most concerned about are those with anticholinergic properties. This means that the medications block the effect of acetylcholine.  Acetylcholine is an important brain chemical and neurotransmitter that becomes less plentiful in the aging brain (those of us over 40). These medications have an impact on brain cells by occupying that cell’s receptor molecules and can help people gain relief from symptoms of insomnia, irritable bowel syndrome, or several other medical conditions.

The consequences of anticholinergic medication usage can be serious.  Side effects include dry mouth, dry eyes, constipation, or urinary retention may occur. The toxic effects of anticholinergic medications on the brain include confusion, memory disturbance, agitation, and even dementia. The classifications of the medications are:

Antianxiety drugs (benzodiazepines)

Benzodiazepines are used to treat a variety of anxiety disorders, agitation, and seizures. Because benzodiazepines have a sedative effect, they are often used to treat insomnia and the anxiety that can accompany depression.

Examples: Alprazolam (Xanax), chlordiazepoxide, clonazepam (Klonopin), diazepam (Valium), flurazepam, lorazepam (Ativan), midazolam, quazepam (Doral), temazepam (Restoril) and triazolam (Halcion).

How they can affect memory: Benzodiazepines reduce activity in key parts of the brain, including those involved in the transfer of information and experiences from short-term to long-term memory. They’re used in anesthesia for this very reason.

Alternatives: Benzodiazepines should be prescribed only rarely in older adults, and then only for short periods. It takes older people much longer than younger people to flush these drugs out of their bodies, and the ensuing buildup puts older adults at higher risk for not just memory loss but delirium, falls, fractures, and motor vehicle accidents. Benzodiazepines are easily very addictive and almost impossible to stop.

If you or your loved one take any of these medications, and you are concerned about memory loss, you must weigh the benefits vs the risks.  It is common to see Benzodiazepines used to treat Alzheimer’s patients who are sundowning. This is an instance where quality of life needs to be considered.   

NEVER STOP TAKING THESE MEDICATIONS COLD TURKEY!  You MUST consult your health care professional before stopping or reducing the dosage of any benzodiazepine. Sudden withdrawal can trigger serious side effects, so a health professional should always monitor the process.

Antiseizure drugs

Antiseizure drugs or anticonvulsants are used to treat epilepsy and symptomatic seizures. A neurologist will select the medication based on the type of seizure, side effects, drug interactions, and other health conditions. These medications can also be prescribed for nerve pain, pain after surgery, bipolar disorder, mood disorders, and mania.

Examples: Carbamazepine (Tegretol), gabapentin (Neurontin), lamotrigine (Lamictal), levetiracetam (Keppra), oxcarbazepine (Trileptal), pregabalin (Lyrica), rufinamide (Banzel), topiramate (Topamax), valproic acid (Depakote), phenobarbital (Luminal), primidone (Mysoline) and zonisamide (Zonegran).

How they can affect memory: Anticonvulsants are believed to limit seizures by dampening the flow of signals within the central nervous system (CNS). Drugs that depress signaling in the CNS can cause memory loss. One thing to note: These medications can be sedating, making it hard to separate what is a true cognitive decline from simple sedation.

Alternatives: Many patients with seizures do well on phenytoin (Dilantin), which, at lower doses, has less of an impact on memory. Patients with chronic nerve pain find that venlafaxine (Effexor) – which also spares memory – alleviates their pain.

NEVER STOP TAKING THESE MEDICATIONS COLD TURKEY!  You MUST consult your health care professional before stopping or reducing the dosage of any antiseizure medication. Sudden withdrawal can trigger serious side effects, so a health professional should always monitor the process.

Tricyclic antidepressants

This is an older class of antidepressant drugs and is prescribed less often these days, but some people still use tricyclics for depression, anxiety disorders, obsessive-compulsive disorder, and nerve-related pain.

Examples: Amitriptyline (Elavil), clomipramine (Anafranil), desipramine (Norpramin), doxepin (Silenor), imipramine (Tofranil), nortriptyline (Pamelor), protriptyline (Vivactil) and trimipramine (Surmontil).

How they can affect memory: Tricyclic antidepressants block the action of serotonin, norepinephrine, and other chemical messengers in the brain, which can lead to several side effects, including memory lapses.

Alternatives: Newer antidepressants like fluoxetine (Prozac), sertraline (Zoloft), and other selective serotonin reuptake inhibitors (SSRIs) don’t have the same anticholinergic effects as tricyclic antidepressants and therefore don’t interfere with cognition.

NEVER STOP TAKING THESE MEDICATIONS COLD TURKEY!  You MUST consult your health care professional before stopping or reducing the dosage of any antidepressant. Sudden withdrawal can trigger serious side effects, so a health professional should always monitor the process.

Narcotic painkillers (opioids)

Narcotics are used to relieve moderate to severe pain from surgery or injuries. In some instances, they can also be used to treat chronic pain. Narcotics are easily addictive and almost impossible to stop.

Examples: Fentanyl (available as a patch), hydrocodone (Vicodin), hydromorphone (Dilaudid, Exalgo), morphine, and oxycodone (Oxycontin). These drugs come in many different forms, including tablets, solutions for injection, transdermal patches, and suppositories.

How they can affect memory: These drugs work by stemming the flow of pain signals within the central nervous system and by blunting one’s emotional reaction to pain. Both these actions are mediated by chemical messengers that are also involved in many aspects of cognition, so the use of these drugs can interfere with long- and short-term memory, especially when used for extended periods. Researchers have also found a link between opioid use and dementia in older adults.

Alternatives: In patients under the age of 50 years, nonsteroidal anti-inflammatory drugs (NSAIDs) are the frontline therapy for pain. Unfortunately, NSAID therapy is less appropriate for older patients, who have a much higher risk of gastrointestinal bleeding.

Acetaminophen (Tylenol) may be another option, but again, it’s important to consult your doctor about risks, side effects, and drug interactions for all medications.

NEVER STOP TAKING THESE MEDICATIONS COLD TURKEY!  You MUST consult your health care professional before stopping or reducing the dosage of any narcotics. Sudden withdrawal can trigger serious side effects, so a health professional should always monitor the process.

Sleeping aids (nonbenzodiazepine sedative-hypnotics)

Sleeping aids are used to treat insomnia and other sleep problems. They are also prescribed for mild nighttime anxiety and sundowning. Sleeping aids are highly addictive!

Examples: Eszopiclone (Lunesta), zaleplon (Sonata), and zolpidem (Ambien).

How they can affect memory: Although these are molecularly distinct from benzodiazepines, they act on many of the same brain pathways and chemical messengers, producing similar side effects and problems with addiction and withdrawal. These sleeping aids also can cause amnesia and sometimes trigger dangerous or strange behaviors, such as cooking a meal or driving a car with no recollection of the event upon awakening.

Alternatives: There are alternative drug and nondrug treatments for insomnia and anxiety, so talk with your healthcare professional about options. Melatonin, for instance, can help to reestablish healthy sleep patterns. Cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for the sleep disorder.

NEVER STOP TAKING THESE MEDICATIONS COLD TURKEY!  You MUST consult your health care professional before stopping or reducing the dosage of any sleeping aid medication. Sudden withdrawal can trigger serious side effects, so a health professional should always monitor the process.

Incontinence drugs (Anticholinergics)

Incontinence medications are used to relieve symptoms of overactive bladder and reduce episodes of urge incontinence, an urge to urinate so sudden and strong that you often can’t get to a bathroom in time.

Examples: Darifenacin (Enablex), oxybutynin (Ditropan XL), solifenacin (Vesicare), tolterodine (Detrol), and trospium (Sanctura). Another oxybutynin product, Oxytrol for Women, is sold over the counter.

How they can affect memory: Patients who take anticholinergics can have complications with their long-term memory. These medications have been associated with an increased risk of dementia, and that heightened risk can persist even after the medication has been discontinued.

Older adults are particularly vulnerable to the other adverse effects of anticholinergic drugs, including constipation (which, in turn, can cause urinary incontinence), blurred vision, dizziness, anxiety, depression, and hallucinations.

Alternatives: As a first step, it’s important to make sure that you have been properly diagnosed. Check with your doctor or another health professional to see if your urinary incontinence symptoms might stem from another condition (such as a bladder infection or another form of incontinence) or a medication (such as a blood pressure drug, diuretic, or muscle relaxant).

Once these are ruled out, try some simple lifestyle changes, such as cutting back on caffeinated and alcoholic beverages, drinking less before bedtime, and doing exercises to strengthen the pelvic muscles that help control urination.

Some urologists are treating overactive bladder with Botox injections to help the muscle relax. Solutions beyond the medicine aisle can also come in handy. There have been huge improvements in protective undergarment items. Please do not call them diapers!  Party pants sound a lot more fun.

Antihistamines (first generation)

Antihistamines are used to relieve or prevent allergy symptoms or symptoms of the common cold. Some antihistamines are also used to prevent motion sickness, nausea, vomiting, and dizziness, and to treat anxiety or insomnia.

Examples: Brompheniramine (Dimetane), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist), diphenhydramine (Benadryl), promethazine (Phenergan) and hydroxyzine (Vistaril).

How they can affect memory: These medications are prescription and available over-the-counter.  They inhibit the action of acetylcholine, a chemical messenger that mediates a wide range of functions in the body. In the brain, they inhibit activity in the memory and learning centers.

Alternatives: Newer-generation antihistamines such as loratadine (Claritin) and cetirizine (Zyrtec) are better tolerated by older patients and do not present the same risks to memory and cognition. My favorite solution to replace an antihistamine is a product from OrthoMolecular called D-Hist (adults) and D-Hist Jr. (kids).  It is just as effective as any antihistamine I have ever used, but it is natural without negative side effects.  For more information on D-Hist – click here:  https://amzn.to/3A9SWeQ .

One of the best lessons I learned in my years working at an independent pharmacy was not to judge anyone for their use of any medication. Not only was it none of my business, but I don’t know anything about what our patients have lived through.

There were always patients who lied about why they needed their pain medications, Adderall or Ambien early.  Some of those patients had a new excuse every month for the 4 years that I was there. But as I got to know all of our patients better, I understood that everyone self-medicates or self-soothes themselves in one way or another. 

Some take a pill to go to sleep so they stop thinking about the trauma, abuse, and/or neglect they experienced when they were younger.  Often the pill they take to escape those thoughts at night requires them to take a pill in the morning to get up and go.  But when they can get up and go, they spend their time serving others.  So don’t judge.

Other people cut themselves, binge eat, drink until they pass out, abuse their family members, shop, abuse street drugs, become sexually inappropriate (whatever you define as inappropriate), rage, fight, or scroll videos on their phones to self-soothe themselves to a point where they can relax, find peace and sleep. 

As you review your and your loved one’s prescription, OTC or recreational drug keep this in mind.  There was a trigger that started the drug use. 

If your 85-year-old Dad needs an Ativan every afternoon at 3pm so he can find some peace and not rage as he is experiencing Alzheimer-related sundowning, OK.

If at 32 you want an Ativan to go with a glass of wine. Talk to your doctor.  You might benefit from therapy to address an issue from your past and a low-dose CBD/THC gummy to relax.  Every situation is different and a loving and kind decision can be made without judgment.

If you are interested in supplementing your body & brain to optimize brain health, this is what I suggest:

All Adults over 40 should take the following:

MultiVitamin

EPA/DHA Fish Oil

Vitamin D3 +K2

Methylated B Vitamins

Tumeric/Curcumin

Berberine

Choline