5 Medications to Avoid If You're Worried About Memory Loss

Concerned about memory loss or thinking changes? One of the most impactful steps you can take is to identify and minimize medications that hinder brain function. This is a cornerstone of geriatric care and a key recommendation from experts like the National Academy of Medicine. Many older adults are unknowingly taking medications, both prescription and over-the-counter, that negatively affect their cognitive abilities, sometimes even increasing the risk of dementia. This article will explore five common categories of these brain-slowing medications.

Why Medication Review is Crucial for Cognitive Health

Optimizing brain function is essential for quality of life as we age. Just because a medication was tolerated well in younger years doesn't guarantee its safety for an older adult. Aging brains are less resilient and more susceptible to the effects of these drugs. Furthermore, many of these medications also increase the risk of falls, making it doubly important to identify and minimize their use.

5 Medication Categories That Can Impact Memory

Here are five common drug categories to watch out for if you're concerned about memory:

1. Benzodiazepines

Often prescribed for sleep or anxiety, benzodiazepines are habit-forming and have been linked to an increased risk of dementia.

• Common Examples: Lorazepam (Ativan), Diazepam (Valium), Temazepam (Restoril), Alprazolam (Xanax).

• Alternatives:  Insomnia requires a comprehensive approach, often involving cognitive behavioral therapy, exercise, and lifestyle changes. Anxiety may be managed with SSRIs (like sertraline or citalopram) or therapies like cognitive behavioral therapy and mindfulness. Never stop benzodiazepines suddenly; always taper under medical supervision.

• Additional Risks: Increased fall risk, potential for abuse.

2. Non-Benzodiazepine Prescription Sedatives

This category includes the "z-drugs" like zolpidem (Ambien), zaleplon (Sonata), and eszopiclone (Lunesta). These can impair thinking and balance in the short term, and some studies suggest a possible link to dementia.

• Alternatives:  See the insomnia alternatives mentioned above. Geriatricians sometimes use low-dose trazodone as a less risky option.

• Additional Risks: Worsened balance and increased fall risk.

3. Anticholinergics

This diverse group includes many over-the-counter sleeping aids, antihistamines (like Benadryl), and various prescription medications. They block acetylcholine, a neurotransmitter vital for brain function. Studies have linked long-term use of anticholinergics to increased risk of cognitive decline and dementia.

• Common Examples: Diphenhydramine (Benadryl), "PM" versions of over-the-counter pain relievers, medications for overactive bladder (oxybutynin, tolterodine), medications for vertigo or nausea (meclizine, scopolamine, promethazine), muscle relaxants (cyclobenzaprine), tricyclic antidepressants (amitriptyline, nortriptyline), and even some SSRIs (paroxetine).

• Alternatives: Alternatives depend on the specific condition being treated. Discuss options with your doctor. Topical creams may replace oral medications for itching, and targeted exercises can sometimes alleviate muscle tightness.

• Additional Risks:  Worsened balance, dry mouth, dry eyes, constipation.

4. Antipsychotics and Mood Stabilizers

These are often prescribed for behavioral issues related to dementia, sometimes inappropriately. They are sedating and can impair brain function. In older adults with dementia, they've been linked to an increased risk of death.

• Common Examples: Risperidone (Risperdal), Quetiapine (Seroquel), Olanzapine (Zyprexa), Aripiprazole (Abilify), Haloperidol (Haldol), Valproate (Depakote).

• Alternatives:  Non-drug approaches should always be explored first, focusing on identifying and addressing the root cause of agitation. Behavioral therapies can also be effective. Medication alternatives may include SSRIs (like citalopram), cholinesterase inhibitors (like donepezil), and memantine.

• Additional Risks: Increased fall risk, increased risk of death.

5. Opioid Pain Medications

While not on the Beers List of medications to avoid in older adults, opioids can still dampen thinking abilities, even with long-term use.

• Common Examples: Hydrocodone, Oxycodone, Morphine, Codeine, Methadone, Hydromorphone, Fentanyl, Tramadol.

• Alternatives: A holistic approach to pain management can often reduce the need for high doses of opioids. In people with dementia, untreated pain can worsen cognitive function, so sometimes low-dose opioids are appropriately used to improve thinking.

• Additional Risks: Potential for addiction, risk of medication theft.

Taking Charge of Your Cognitive Health

Understanding these common medications that can affect memory is crucial for proactive cognitive health management. If you have concerns about medications you're taking, discuss them with your doctor or pharmacist. Don't hesitate to explore non-drug alternatives and prioritize a holistic approach to wellness.