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Medications that Cause Dementia

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By Dr. John Neustadt

Most drug side effects are not known until it has been on the market for five or ten years. That’s because drug companies test their products in carefully controlled patient populations that don’t mimic the real world. Prescription medications cause 46 million adverse reactions annually in the US, resulting in more than two million hospitalizations and killing more than 110,00 people.

That’s why doctors and patients didn’t know that bisphosphonate medications (e.g., Fosamax, Zometa, Actonel) for bone health cause fractures and osteonecrosis of the jaw (ONJ) until many years after the FDA approved them. Acid-blocking medications are associated with an increased risk for hip fractures by 22% after one year and nearly 60% after four years. A 2018 study published in the journal Gut concluded that the risk of stomach cancer increased by 500% after just one year in people taking acid blockers compared to those who did not take them. 

Now, we can add delirium and dementia to the growing list of side effects from some of the most commonly prescribed drugs. Up to 12% of cases of dementia are caused by medication toxicity. People with delirium experience disorientation, poor short-term memory, and an altered level of consciousness. Among the long list of dementia symptoms are memory loss, confusion, difficulty handling complex tasks, anxiety, depression, agitation, and hallucinations. 

Acid blockers

Every day, millions of people take acid-blocking medications to treat the symptoms of acid reflux, for duodenal ulcers, and as an important part of a treatment strategy to kill the H. pylori infection. The US FDA approved these medications for short-term use, including popular brands such as Prilosec, Protonix, and Zantac. However, people often end up taking these medications for years, even though the FDA never approved them for longer than a couple of months.

A 2016 study published in JAMA Neurology concluded that acid-blocking medications are associated with increasing dementia risk. The German study evaluated medical records of 73,679 people ages 75 and older. Researchers found that regular PPI use increased dementia risk by 44% compared with those not using the drugs. While more research still needs to be done on this issue to understand if there is a direct cause-and-effect relationship in humans, mice fed PPIs experienced an accumulation of beta-amyloid plaque in their brains. This unhealthy protein is known to be a major contributing factor in the development of dementia.

For natural ways to combat acid reflux that don’t involve medications, read my blog, Stop the Burn—7 Proven Ways to Stop Acid Reflux.

Anxiety and sleep meds

One of the most common categories of medications prescribed for anxiety and to help people sleep is benzodiazepines. These drugs are also called Z-drugs and Z-like drugs. They go by the names Ambien, Halcion, Prosom, Lunesta and Sonata. A 2019 study published in the Journal of Clinical Neurology reviewed data from 10 published studies on the long-term use of benzodiazepines. They concluded that the risk for dementia increased by up to 95% in people taking these medications compared to patients who were not taking them. And the longer someone took the medication, the greater their risk. 

A 2005 study published in the British Medical Journal (BMJ) concluded that in patients over 60 years old, the dangers of these sleep medications are outweighed by the risks. In other words, these medications are more likely to hurt than help. 

If you struggle with sleep, read my blog, Your Checklist for Better Sleep, for tips on how you can naturally improve your sleep. 

Drug cocktails (polypharmacy)

One of the big problems is that people are taking a cocktail of medications, called polypharmacy, that have never been studied together. Drugs going through FDA approval aren’t tested for the cumulative effects and problems that combining medications can have, which happens in real life. 

Fifty-five percent of Americans now take at least one drug, and almost 12% take five or more prescription drugs. The odds of experiencing cognitive impairment (e.g., delirium or dementia) increase with the number of prescription drugs someone takes. This is not new information, but unfortunately, it doesn’t seem to be on most doctors’ radars. An Archives of Internal Medicine article concluded that the risk is nine times greater for patients taking four or more medications than those taking fewer prescriptions. 

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References

Cheung KS, Chan EW, Wong AYS, Chen L, Wong ICK, Leung WK. Long-term proton pump inhibitors and risk of gastric cancer development after treatment for Helicobacter pylori: a population-based study. Gut. 2018;67(1):28-35. [Article]

Glass J, Lanctot KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331(7526):1169.

Gomm W, von Holt K, Thomé F, et al. Association of proton pump inhibitors with risk of dementia: A pharmacoepidemiological claims data analysis. JAMA Neurology. 2016;73(4):410-416. [Article]

He Q, Chen X, Wu T, Li L, Fei X. Risk of Dementia in Long-Term Benzodiazepine Users: Evidence from a Meta-Analysis of Observational Studies. J Clin Neurol. 2019;15(1):9-19. [Article]

Katz IR, Parmelee P, Brubaker K.  Toxic and metabolic encephalopathies in long-term care patients.  Int Psychogeriatr 1991; 3:337-347. [Article]

Klein E, Bourdette D. Postmarketing adverse drug reactions: A duty to report? Neurol Clin Pract. 2013;3(4):288-294. [Article]

Larson EB, Kukull WA, Buchner D, Reifler BV. Adverse drug reactions associated with global cognitive impairment in elderly persons. Ann Intern Med 1987;107:169-173. [Article]

Lazarou J, Pomeranz BH, Corey PN. Incidence of adverse drug reactions in hospitalized patients: a meta-analysis of prospective studies. JAMA. 1998;279(15):1200-1205. [Article]

Number of Retail Prescription Drugs Filled at Pharmacies by Payer. 2018; Accessed August 28, 2019.

Starr JM, Whalley LJ.  Drug induced dementia: incidence, management and prevention. Drug Safety 1994; 11:310-317. [Article]

Yang YX, Lewis JD, Epstein S, Metz DC. Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA. 2006;296(24):2947-2953. [Article]

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