Is It Dementia or 'Medication Fog'?

As we age, the list of medications we have to take on the daily to maintain a healthy and active life begins to lengthen. At the same time, the ability of the body to compensate for the side effects of these medications decreases with age, and some medications may start making us more confused, drowsy and apathetic - a side effect known by the name ‘medication fog’.

The problem is that many patients, caregivers, and even doctors can overlook the probability of medication fog, and tend to link the above-mentioned symptoms with a neurodegenerative disease that exhibits identical symptoms - dementia. To learn more about medication fog and how to distinguish it from dementia, continue reading.

What Is Medication Fog?

Many common medications have an anticholinergic effect on the brain, meaning that they reduce or interfere with the way our nerves function. When we’re young, our nerve cells are capable of compensating for those effects, and so we don’t feel like our brain is essentially “slowing down”, but with age, we notice the effect of medication on our cognitive health more and more.

Several of these medications, even those we could previously take, can manifest themselves in the following symptoms:

    Difficulty concentrating
    Dizziness
    Confusion
    Drowsiness.

These side effects together create the medication fog.

Unfortunately, with age, one’s risk of dementia also increases, and many cases of medication side effects end up being misdiagnosed as dementia. Note that some of these medications can also worsen dementia symptoms in those who do suffer from the condition.


As you may imagine, pinpointing “medication fog” can be difficult, especially if you’re on several medications already. And most seniors are. The average American senior between the age of 65 and 69 takes 14 different prescription medications, and this number rises to 18 in the age range of 80-84. These statistics are very similar in other countries, and it makes sense because many older adults are in dire need of daily medication. However, with such a high number of pills and other treatments one needs to take daily, it becomes increasingly difficult to track the side effects of each medication.

Still, there are ways you and your doctor will be able to distinguish medication fog from dementia. To do so, ask yourself the following questions:
1. Did you start feeling worse once you started a new prescription medication or increased the dose of a medication you're used to taking?
2. Are your symptoms more pronounced shortly after you've taken an over-the-counter medicine, such as a painkiller or allergy medication?
3. Does a specific combination of medications you take on a specific day make you feel worse than usual? 

If you answered 'Yes' to any of these questions, medications may be the cause of your cognitive symptoms. Consider discussing a specific medication or a combination of medications (even if they're over-the-counter) with your doctor. They will be able to help you replace the medication in question or adjust the dosage to make you feel better.

Which Medications Are Capable of Causing Medication Fog?

Anticholinergic drugs (those that treat an overactive bladder, lung issues, excessive sweating, etc.) are the main culprit behind medication fog, according to the recently updated list of such medications by the American Geriatrics Society, but many other meds, even those available over-the-counter and nutritional supplements can cause this side effect. These medications include:

    Painkillers
    Sleep medications
    Antidepressants
    Antihistamines and allergy medications
    Muscle relaxants
    Stomach acid treatments, and others.

To access a certain drug's capacity to affect your cognitive health, you can look at the listed side effects of the medication on the leaflet that comes with the medicine or search for the information on medical apps and websites. You can also discuss the question with your doctor: simply compile a list of the meds you're currently taking (including OTC medications and supplements) and tell your doctor about the symptoms you're experiencing. Chances are that adjusting the dosage or replacing some medication could improve your cognitive health and decrease the symptoms of medication fog.

 

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Certain Antidepressants Linked to Increased Dementia Risk

Preventing dementia has become a top goal for medical experts as cases continue to rise. The most common form of dementia, Alzheimer’s disease, is the sixth leading cause of death in the United States. 

Now a new large study published  provides evidence that a certain type of common drug may increase the risk of developing dementia. 

Researchers concluded that people who took class 3 anticholinergic drugs were more likely to develop dementia, even if they took the drugs years before they developed the condition. 

Anti-cholinergic drugs are able to block a neurotransmitter chemical called acetylcholine in the central or peripheral nervous system.

Depending on which part of the nervous system is affected, it can result in a myriad of reactions.

As a result, it’s been used to treat a variety of conditions, including epilepsy, depression, hay fever, urinary incontinence, and Parkinson’s disease symptoms.

What the study revealed

Researchers looked at 40,770 people with dementia and 283,933 people without the disease between 2006 and 2015 to see if the drugs were associated with an increased risk of the condition.

The study found that people with dementia were more likely to have taken the stronger class 3 anticholinergic drugs before they developed dementia. The increased risk varied for different types of drugs, but went up to 30 percent in certain cases.

A neurologist and author , explained that the study was a strong one due to its large size and the use of U.K. healthcare databases.  

“Unlike many other studies which rely on patient recall, this study did not, which was a major strength,” the Dr. added. “Anticholinergic medications can potentially lower the levels of the brain chemical acetylcholine, which is an important messenger in memory pathways. In this study, use of some (not all) anticholinergic drugs, even as far back as 20 years, previously raised the risk for dementia.”

She pointed out that not all anticholinergic drugs are the same, and some classes didn’t show an increased risk of dementia. 

“It was only those drugs with very strong anticholinergic activity that were associated with later dementia,” she said. “Important to note that the drugs did not cause dementia, but the use of the drugs raised the risk for dementia. What this means for us as physicians is to be cautious about the use of such drugs in patients and to use it for as short a time as possible.” 

The study’s findings don’t mean patients should always avoid class 3 anticholinergics.

The overall risk to people on these drugs remains relatively low.

For example, a person between 65 and 70 years old has about a 10 percent chance of developing dementia in the next 15 years. If they take anticholinergic antidepressants, they’d have a 19 percent increased risk of dementia. That translates to an additional 1 to 3 more people out of 100 who would receive a dementia diagnosis.

How the research helps doctors, patients

A researcher and one of the co-authors of the study, said the research can provide experts with more evidence to help them make informed decisions about whether or not to prescribe the medication. “We found that people who had been diagnosed with dementia were up to 30 percent more likely to have been prescribed specific classes of anticholinergic medications,” he said in a statement. “And the association with dementia increases with greater exposure to these types of medication.”

However, the researchers made clear they can’t say for certain that this medication causes dementia — just that it’s associated with increased risk. 

“It could be that these medications are being prescribed for very early symptoms indicating the onset of dementia,” he said. “But because our research shows that the link goes back up to 15 or 20 years before someone is eventually diagnosed with dementia, it suggests that reverse causation, or confounding with early dementia symptoms, probably isn’t the case.”

A Dr. said in a statement that physicians should think twice about ordering prescriptions for these medications.

Experts already knew that using these drugs could affect cognition and shouldn’t be used in older, frail patients, according to the study authors. 

“Physicians should review all the anticholinergic medications — including over-the-counter drugs — that patients of all ages are taking and determine safe ways to take individuals off anticholinergic medications in the interest of preserving brain health,” the Dr. said in a statement.

Preserving brain health is key. The Alzheimer’s Association states that the number of Alzheimer’s disease cases alone is expected to nearly triple by 2050.

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