Brain scans link physical changes to cognitive risks of widely used class of drugs

Brain scans link physical changes to cognitive risks of widely used class of drugs
Older adults might want to avoid a using class of drugs commonly used in over-the-counter products such as nighttime cold medicines due to their links to cognitive impairment, a research team led by Shannon Risacher, Ph.D., and other scientists at Indiana University School of Medicine has recommended. Using brain imaging techniques, the researchers found lower metabolism and reduced brain sizes among study participants taking the drugs known to have an anticholinergic effect, meaning they block acetylcholine, a nervous system neurotransmitter. Credit: Indiana University School of Medicine

Older adults might want to avoid a using class of drugs commonly used in over-the-counter products such as nighttime cold medicines due to their links to cognitive impairment, a research team led by scientists at Indiana University School of Medicine has recommended.

Using brain imaging techniques, the researchers found lower metabolism and reduced brain sizes among study participants taking the drugs known to have an anticholinergic effect, meaning they block acetylcholine, a nervous system neurotransmitter.

Previous research found a link between between the anticholinergic drugs and and increased risk of dementia. The new paper published in the journal JAMA Neurology, is believed to be the first to study the potential underlying biology of those clinical links using neuroimaging measurements of and atrophy.

"These findings provide us with a much better understanding of how this class of drugs may act upon the brain in ways that might raise the risk of cognitive impairment and dementia," said Shannon Risacher, Ph.D., assistant professor of radiology and imaging sciences, first author of the paper, "Association Between Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy in Cognitively Normal Older Adults."

"Given all the research evidence, physicians might want to consider alternatives to anticholinergic medications if available when working with their older patients," Dr. Risacher said.

Drugs with are sold over the counter and by prescription as sleep aids and for many chronic diseases including hypertension, cardiovascular disease, and chronic obstructive pulmonary disease.

A list of anticholinergic drugs and their potential impact is at http://www.agingbraincare.org/uploads/products/ACB_scale_-_legal_size.pdf.

Scientists have linked anticholinergic drugs among older adults for at least 10 years. A 2013 study by scientists at the IU Center for Aging Research and the Regenstrief Institute found that drugs with a strong anticholinergic effect cause cognitive problems when taken continuously for as few as 60 days. Drugs with a weaker effect could cause impairment within 90 days.

The current research project involved 451 participants, 60 of whom were taking at least one medication with medium or high anticholinergic activity. The participants were drawn from a national Alzheimer's research project—the Alzheimer's Disease Neuroimaging Initiative—and the Indiana Memory and Aging Study.

To identify possible physical and physiological changes that could be associated with the reported effects, researchers assessed the results of memory and other cognitive tests, positron emission tests (PET) measuring brain metabolism, and magnetic resonance imaging (MRI) scans for brain structure.

The cognitive tests revealed that patients taking anticholinergic drugs performed worse than not taking the drugs on short-term memory and some tests of executive function, which cover a range of activities such as verbal reasoning, planning, and problem solving.

Anticholinergic drug users also showed lower levels of glucose metabolism—a biomarker for brain activity—in both the overall brain and in the hippocampus, a region of the brain associated with memory and which has been identified as affected early by Alzheimer's disease.

The researchers also found significant links between brain structure revealed by the MRI scans and anticholinergic use, with the participants using anticholinergic drugs having reduced brain volume and larger ventricles, the cavities inside the .

"These findings might give us clues to the biological basis for the cognitive problems associated with anticholinergic drugs, but additional studies are needed if we are to truly understand the mechanisms involved," Dr. Risacher said.


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Using anticholinergics for as few as 60 days causes memory problems in older adults

Journal information: Archives of Neurology

Provided by Indiana University
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Apr 18, 2016
Was this a clinical trial or an observational study comparing subjects taking Anticholinergic drugs versus those not? So, is it the drug or the reason they are taking the drug that is the real predictor of cognitive impairment? Patients seek medical intervention when their condition takes a turn for the worse, which may also include cognitive as well as physical impairment and coincide with prescribed drugs. Even so, it is wise to be cautious of these drugs.

Apr 19, 2016
There is a lot of vital info that is missing here. It's only muscarinic acetylcholine antagonists that cause problems, not nicotinic acetylcholine antagonists. This is because nicotinic receptors easily upregulate within a few weeks whereas muscarinic receptors have no such luck. This is easily demonstrable by comparing the anticholinergic effects of diphenhydramine with memantine, for example.

Secondly, if someone is using muscarinic anticholinergics at night, they can still use racetams in the daytime, especially including but not limited to piracetam and phenylpiracetam to compensate for and undo the nighttime damage.

Finally, if one is using antihistaminergics having an anticholinergic effect for sleep, the bottom line is that one needs alternative safe drugs to help sleep instead, and this can be tricky. Long term use of benzodiazepines or Z drugs for sleep is hazardous in their own ways.

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