These Common Medications May Put You At a Greater Risk of Developing Dementia

Source: Flickr user Vince Alongi. 

Speaking personally, I can think of fewer diagnoses that I find more terrifying than dementia, of which Alzheimer's disease makes up about 70% of all cases. I watched my grandmother deal with dementia for the greater part of a half-decade and learned firsthand what a crippling disease it really is.

Dementia cases on the rise
Of course, my grandmother's disease and ultimate cause of her passing wasn't unique. According to the Alzheimer's Association, one in three seniors dies with Alzheimer's or some other form of dementia these days. Alzheimer's is also the sixth-leading cause of death in the United States. Based on estimates from the World Health Organization, between 2012 and 2030, the number of people around the globe with dementia is expected to nearly double to 65.7 million cases.

Source: Centers for Disease Control and Prevention.

Dementia is also a very costly disease to treat, with an estimated $600 billion spent on caring for those afflicted by the disease. This figure not only includes medication and hospital care, but also nursing home and home-health aide expenses.

Dementia is particularly scary because there are still so many unknowns as to why one person develops the disease and another doesn't. Age and family history are the more obvious risk factors that can lead to a higher risk of developing dementia, but a handful of other factors (diabetes, obesity, smoking, and high cholesterol) may play a role, although a lot of additional study is needed for confirmation. 

Unfortunately, a fresh study out of the Group Health Research Institute last week, which was published in JAMA Internal Medicine, showed that some very common medicines, some of which are nonprescription and likely found in your medicine cabinet, could be responsible for an increased risk of developing dementia.

These medications may increase your risk of dementia
Group Health Research Institute conducted a study on 3,434 participants aged 65 and older that began collecting data in 2004 and includes its data set through the end of 2012. The study, known as Adult Changes in Thought, or ACT, was designed to test whether anticholinergic drugs built up in the body over the long term could lead to an increased risk of dementia in patients. The results seemed to demonstrate exactly that, with 797 participants (23.2%) developing dementia (79.9% of all dementia cases were Alzheimer's disease). It should be noted, however, that the study did not provide a control group incidence rate for dementia, meaning further research will be needed.

Furthermore, even after patients stopped taking anticholinergic drugs, there was no guarantee the adverse effects were reversible, as levels of the drug may have built up in patients' bodies over time.

Source: Flickr user Tama Leaver.

An anticholinergic drug is a class of drug generally prescribed by a physician that blocks the neurotransmitter acetylcholine in the brain. Anticholinergic drugs are used to treat incontinence, asthma, muscular spasms, depression, and sleep disorders. Good examples of anticholinergic drugs include Benadryl, Wellbutrin and Zyban, Dramamine, Advil PM, and Unisom. Note that medicines like Dramamine, Benadryl, and Advil PM can be purchased over the counter. Do these sound like any medications you currently have in your medicine cabinet?

Study researchers urge seniors to share OTC medication history with their primary care provider, and even more importantly suggest that primary care physicians focus on prescribing medications outside of the anticholinergic drug class where applicable. Or, in cases where no other alternatives exist, prescribe the lowest needed dose.

Researchers also warned that stopping anti-cholinergic meds cold turkey may not be wise, either, and that patients should contact their physician before discontinuing any medication.

Further data is expected to be extracted from this study for decades to come. Some participants have agreed to let researchers autopsy their brains upon their death so as to determine if there were pathologies in their brains that predisposed them to developing Alzheimer's-related dementia, or if perhaps the anticholinergic drugs played a key role. In other words, this case is by no means closed yet, although it is quite suggestive that these drugs could represent a risk factor when used regularly over the long term.

One important revelation
This study brings to light one important aspect of dementia: We need better medications to tackle this disease. Obviously, pharmaceuticals companies may have a better opportunity to tackle dementia and Alzheimer's disease once researchers have a good grasp on what triggers the disease in the first place, but in the meantime, we need biopharmaceutical companies willing to develop treatments capable of slowing the progression of this disease with the data we currently have.

The fortunate news is we do have a number of drug hopefuls that may be just years away from improving Alzheimer's and dementia patients' quality of life. This is particularly great news because Alzheimer's and dementia drugs have historically had a bad track record for success in clinical studies.

Source: AstraZeneca. 

Perhaps no experimental compound has gained more notoriety in recent weeks than Biogen Idec's (BIIB 0.97%) BIIB037, which is currently being shuffled directly from phase 1 to phase 3 trials. In phase 1 clinical studies, BIIB037, which is targeted specifically at Alzheimer's disease, delivered encouraging results of beta amyloid reduction for patients with early signs of the disease. The 54-week study, which included around 200 patients, will have its data revealed in full later this year, but it showed improved cognitive function in those taking the drug in its early stage study.

Another pathway drug developers are taking to battle Alzheimer's, the most common form of dementia, is BACE inhibitors. Simply put, BACE inhibitors stop or slow the formation of beta amyloid, the plaque that floats around in an Alzheimer's patient's brain that can lead to cognitive decline. While previous BACE inhibitors have failed, select big pharmaceutical companies still believe there's hope in stopping or slowing beta amyloid progression via this pathway.

Last September, AstraZeneca (AZN 0.01%), which is developing AZD3293, partnered with Eli Lilly (LLY -2.24%) to help develop the drug as a potential Alzheimer's treatment. In very early stage treatment, it exhibited a reduction in beta amyloid levels, which is a good early sign of efficacy. Of course, you may need to temper your expectations, here, as AstraZeneca has only assigned a 9% chance of the drug making it through clinical trials.

Merck (MRK 0.29%) also has a BACE inhibitor currently being studied in moderate to severe Alzheimer's patients known as MK-8931 that cleared a big safety hurdle in late 2013. The company's EPOCH and APECS studies should, I figure, yield results sometime in 2016.

Plenty of work left to be done
Seeing high-profile drug developers taking on Alzheimer's and dementia is an encouraging sign, especially since it comes at a time when a lot of very important questions -- such as how dementia is triggered in the first place -- are still mostly unknown.

In addition to discovering new medications to combat dementia, and perhaps eventually cure dementia, researchers need to continue working on ways of detecting dementia early, as it's been proposed that early detection and treatment is the key to slowing the progress of this disease. I do believe there's the potential for a cure one day, but the advancements against dementia are likely to come one baby step at a time.