Taking multiple medications may increase risk of dementia, research shows

By Deep Shukla

Polypharmacy is associated with an increased risk of dementia, highlighting the importance of an integrated approach to care. Westend61/Getty Images

• The use of multiple prescription drugs, known as polypharmacy, is associated with an increased risk of adverse reactions and interactions between different drugs.
• Studies suggest that polypharmacy is associated with an increased risk of dementia.
• A recent study characterizing patterns of polypharmacy before a dementia diagnosis showed that patterns of medication use became increasingly similar as subjects approached the date of diagnosis.
• The results represent a step toward understanding the role of prescription patterns in the development of dementia and optimizing medication use to reduce the risk of drug-drug interactions.

Studies suggest that the simultaneous use of multiple medications is associated with an increased risk of dementia.

But the patterns of medication use in older adults before the diagnosis of dementia are not well-characterized.

A recent study published in Aging and Disease used machine learning algorithms to characterize changes in the patterns of medication use and co-occurring chronic conditions during the 20-year period before a dementia diagnosis.

The results showed that patterns of medication use were similar as subjects approached the date of their diagnosis, highlighting a need for a more integrated approach to care for individuals with dementia.

“Given the rise in dementia cases internationally, the need to understand how patterns of polypharmacy evolve before and after a dementia diagnosis is important for devising a safe treatment program for each patient,” study author Shang-Ming Zhou, BSc, MSc, Ph.D., a professor of e-Health at the School of Nursing and Midwifery at the University of Plymouth in the United Kingdom, said in a news release.

“Our aim in this study was to help doctors find ways to prescribe multiple items of dementia medication safely and without reducing their effectiveness. The use of machine learning has been vital in helping us understand how these patterns develop, and our hope is we can now use this knowledge to treat patients.”

– Shang-Ming Zhou, BSc, MSc, Ph.D., lead author of the study

Effects of polypharmacy

As people get older, some may experience a greater number of co-occurring chronic health problems.

The presence of multiple chronic conditions is associated Trusted Sourcewith an increase in the concomitant use of multiple prescription medications.

In addition, healthcare providers may also prescribe medications as a preventive measure to reduce the risk of occurrence of chronic conditions such as cardiovascular disease (CVD) in the future or prevent their progression.

With an increase in the number of preventive medications that are simultaneously used, the benefit derived due to the use of each medication often declines.

The increase in the number of medications can also increase the risk of adverse effects and interactions between the different medications. In addition, polypharmacy is associated with an increase in the risk of drug-disease interactions, whereby the medications used to treat one disease can worsen the symptoms of another condition.

Consistent with this, polypharmacy is associated with negative clinical outcomes, including an increased riskTrusted Source of hospitalization and death among older adults. Moreover, treatment guidelines for various conditions do not necessarily account for physiological changes that occur with aging.

The use of multiple medications may also make it challenging for the person with dementia to adhere to the prescribed schedule.

However, researchers caution that only the inappropriate use of multiple medications — such as combinations that may interact with or cause additive side effects — is specifically harmful.

By contrast, the use of multiple medications can be effective if the combination is appropriately prescribed by an interdisciplinary team using the best available evidence.

Undertreatment can be as problematic as over-prescription, and researchers have notedTrusted Source that it is essential to ensure that older individuals receive the optimal combination of medications that are specific to their needs. 

Dementia and polypharmacy

Dementia is a neurological condition characterized by a gradual and progressive decline in cognitive function.

In addition to deficits in thinking, memory, judgment, and language, individuals with dementia may also show behavioral and psychological symptoms such as depression, agitation, and anxiety. Thus, individuals with dementia are often prescribed multiple medications to manage these symptoms.

A 2019 meta-analysis showed that the simultaneous use of multiple medications was associated with an increased risk of dementia.

What’s more, the use of one or more anticholinergic drugs that are used to treat conditions such as cardiovascular diseases, respiratory disorders, and overactive bladder is associated with an increased risk of cognitive impairment and dementia.

Thus, it is essential to characterize the patterns of medication use before the diagnosis of dementia to better understand the role of these patterns in the development of dementia and reduce the risk of drug-drug interactions.

Patterns of polypharmacy before dementia

In the present study, the researchers examined the patterns of polypharmacy, defined as the intake of three or more medicines, over a 20-year period before the diagnosis of dementia in 33,451 individuals.

The researchers used electronic records from primary healthcare providers to obtain data on the prescription of medications and disease diagnosis during the 20-year period prior to the diagnosis of dementia. The 20-year period before the dementia diagnosis was divided into four periods of 5 years each.

The researchers found that the prevalence of individuals using three or more medications increased as their age increased, and they approached the date of dementia diagnosis.

The fraction of individuals living with dementia using three or more medications increased from 5.5% between 16 to 20 years before the dementia diagnosis to 82% during the five-year period preceding the diagnosis.

The researchers then used algorithms to identify clusters of medications that were commonly used together in each of the four time periods. For instance, during the 5-year period prior to the diagnosis of dementia, the researchers identified three distinct patterns.

The first cluster accounted for 66% of subjects and included medications for respiratory and urinary tract infections, osteoarthritis and other related conditions, and cardiovascular diseases.

The second cluster included 22% of subjects and included medications for diabetes, depression, and anxiety in addition to those present in the first cluster.

In addition, a third cluster accounted for 2% of the subjects and included medications for osteoarthritis and related conditions.

Among these clusters, the researchers found medications that have been shown to interact with each other or worsen the symptoms of other chronic conditions.

Similarly, the researchers identified multiple clusters of medications for the remaining three time periods.

As the time from the date of dementia diagnosis increased, the number of clusters or patterns of medication use also increased. For example, the researchers identified 6 clusters for the time window from 11 to 15 years before the date of dementia diagnosis in comparison with 3 clusters during the 5-year period prior to the diagnosis.

Comorbid health conditions and dementia diagnosis

As the time from dementia diagnosis increased, each cluster consisted of fewer medicines, and the number of individuals in each cluster became smaller.

Thus, during the 5-year period closest to the dementia diagnosis, two clusters, especially the first cluster, included a large number of medicines and accounted for a majority of individuals (66%).

The larger number of medicines in these clusters suggests that the number of co-occurring conditions increased as subjects moved closer to the date of dementia diagnosis.

Moreover, the larger number of subjects in these clusters suggests they were more likely to show similar patterns of co-occurring chronic conditions and polypharmacy as they approached the date of dementia diagnosis.

These results highlight the importance of an integrated or holistic approach to care for individuals with dementia.

Dr. David A. Merrill, Ph.D., psychiatrist and director of the Pacific Neuroscience Institute’s Pacific Brain Health Center in Santa Monica, CA, not involved in the study, told Medical News Today:

“The brain is much like the kidney and the heart in terms of being an end-organ that is significantly affected by systemic diseases and the treatments for those conditions. It’s important to take the effects of medication on the whole body into account, even when treating a localized infection like bronchitis or aches and pains from arthritis. The medication choices made over the years with a patient can significantly impact the course of heart and kidney disease and brain health.”

The researchers noted that their study did not examine patterns of polypharmacy in individuals without dementia, and some of the patterns observed in the study could be due to the effects of aging.

Thus, further research is needed to establish causality between the patterns of polypharmacy characterized in the study and dementia.

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Taking multiple medications may increase risk of dementia, research shows

A Startling Cause of Misdiagnosed Dementia

The Kaiser Foundation recently reported that the average senior is taking six prescription drugs daily. Many add one or two new prescriptions to their daily routine each year, and often, the senior and the senior loved one’s family do not fully understand which pill does what, when to take each pill or what side effects to look out for.

Learn more about how this can lead to a misdiagnosis of illness, and even, medication induced Alzheimer’s disease or dementia.

 

How Medication Side Effects Can Masquerade as Dementia

Drug interactions and side effects often mimic the symptoms of age-related cognitive disorders. For instance, drugs that affect cognition and mobility, such as anti-anxiety meds, can make dementia symptoms worse — or even create a facade of dementia in people who don’t suffer from the disease, a condition known as pseudodementia.

For instance, many anti-anxiety drugs commonly prescribed to seniors such as Valium and Xanax, have side effects that are indistinguishable from Alzheimer’s or dementia, including:

• Short-term memory loss
• Disinhibition
• Hallucinations

Other medications can also cause pseudodementia, including cholesterol lowering statin drugs like Lipitor, which many seniors take. In fact, any medicine that can cause cognitive impairment could lead to a misdiagnosis of dementia. Classes of drugs including anti-histamines, antibiotics, corticosteroids, anticonvulsants, antiemetics, muscle relaxants and opioid pain killers all carry this risk.

While the right medicine can reverse the course of serious diseases and improve a senior’s quality of life immeasurably, medications also cause problems. We received this comment on our Senior Living Blog, which is worth quoting:

“My mother was fading fast. In the course of two months, she went from needing general assistance to not being able to stand or assist with her own transfers… Over the course of about three weeks, she had deteriorated to the point where she could not take her medications. Without meds, she regained her mind and most of her mobility. It came down to the medications she was on. We began reintroducing them one at a time with minimal doses for the most important issues. If we saw a return of symptoms of dementia, we would reverse course and she would come right back. It has made me wonder how many of our elderly end up in homes, or deteriorate catastrophically because they are on too much medication. ”

Senior Living and Medication Care Plans

For many seniors, a move to an assisted living community can help get this medication chaos under control. Most assisted living communities require that residents have a doctor’s visit before admission. Families and physicians often use this visit as an opportunity to “press the reset button” on prescriptions. A complete reassessment of the senior’s medication regime can take place at this time. Under doctor’s supervision, many seniors are able to go off of medicines that are redundant or have outgrown their usefulness.

Once a senior is admitted to assisted living, a care plan is put in place. Care plans lay out goals and strategies for the resident’s care, and medicines are a big part of the equation. The community, family, senior and medical professionals discuss what medicines will be given to the resident, why, and often set goals for reducing them. In fact, seniors, particularly those with Alzheimer’s and dementia, are often able to reduce their medications after moving to assisted living communities with memory care.

In fact, many seniors who have been prescribed anti-anxiety medications find themselves in an undignified stupor that’s not only painful for loved ones to witness, but also can lead to falls, head injuries and broken bones. Today’s memory care communities attempt to reduce this agitation and anxiety non-chemically, with methods such as:

• Purposefully designing communities to make people with memory loss feel comfortable
• Using therapy which reduces a senior’s blood pressure, improves mood and decreases anxiety
• Encouraging family visits and community involvement

Loren Shook, CEO of Silverado Senior Living, which specializes in memory care, confirms that many residents who move to Silverado communities are able to significantly reduce their medicine intake, and with great benefit.

Medication Management and Healthy Senior Living

While decreasing the amount of prescribed medications is ideal, it’s not always possible. In some cases, seniors require every medicine they’re prescribed. But even in these cases, assisted living plays an important role. Even if medicines can’t be reduced, it’s important that that they be taken correctly. Medication management, which is offered at nearly all assisted living communities, assures that seniors get the right medicine, at the right dose, at the right time. For seniors with multiple medicines, or with memory loss, this benefit alone can be a lifesaver.

If your older loved one is on multiple medicines, or is showing changes that you believe may be related to drug interactions, arrange a doctor’s visit to reevaluate medications. Talk to the doctor about what medicines are essential, and which may be doing more harm than good.

If your older loved one cannot take medication safely, and you can’t be there to help, consider memory care or residential home care. Our Senior Living Advisors can help your family find the most appropriate options for loved one.

Full Article & Source:
A Startling Cause of Misdiagnosed Dementia