March 9 (UPI) — Older adults who take three or more drugs for dementia or its complications could accelerate memory loss and declines in thinking ability as a result, according to a study published Tuesday by JAMA.
Despite this risk, one in seven adults with dementia in the United Stated who is older than 65 and lives outside of a nursing home takes three or more drugs to treat dementia or related disorders, such as depression, the data showed.
This so-called “poly-pharmacy,” or taking multiple prescription drugs, also can raise the risk for injury and death in the elderly, as some of these medications can cause fatigue, weakness and delirium.
“Dementia comes with lots of behavioral issues, from changes in sleep and depression to apathy and withdrawal, and providers, patients and caregivers may naturally seek to address these through medications,” study co-author Dr. Donovan Maust said in a press release.
However, “the evidence supporting the use of many of them in people with dementia is pretty thin,” said Maust, an associate professor of psychiatry at University of Michigan Medicine in Ann Arbor.
People with dementia may be prescribed drugs that act on their central nervous system for behavioral reasons, despite the fact that the medications may speed their cognitive decline, according to the researchers.
In some cases, the medications may be prescribed in response to the distress that a caregiver feels when seeing their loved one behave in a certain way, the researchers said.
Still, experts generally advise against poly-pharmacy in the elderly, as drugs taken simultaneously can interact and raise the risk for falls, overdoses and memory issues.
“I would encourage everyone involved in a dementia patient’s care to think about whether there are alternatives to medication,” New York City-based geriatrician Howard Fillit, who was not part of the JAMA study, told UPI.
“For example, if a patient gets agitated periodically, try to figure out what’s triggering the agitation and see if you can alter the stimulus to correct the behavior without medication,” said Fillit, who also is founding executive director of the Alzheimer’s Drug Discovery Foundation.
For this study, the researchers analyzed data on 1.2 million people with dementia covered by Medicare and focused on the medications they were taking, including antidepressants, sedatives used as sleep medications, opioid painkillers, antipsychotics and anti-seizure drugs.
Of the 1.2 million people included in the analysis, more than 831,000 received at least one of the medications at least once in 2018, the data showed.
More than 535,000 of them, or nearly half, took one or two medications for more than a month.
Even though antipsychotics such as quetiapine, which is marketed as Seroquel, aren’t approved for people with dementia, they’re often prescribed to treat agitation and sleep issues, Maust said.
Among the study participants, 47% of those who take three or more of the medications received at least one antipsychotic.
However, nearly all — 92% — of those on three or more of the medications were taking an antidepressant, and 62% were taking an anti-seizure medication, such as gabapentin.
Although anti-seizure drugs are used to treat epilepsy, few of these older adults had a seizure disorder, though Maust noted that it’s possible the drugs were prescribed to treat pain or anxiety.
Another 41% of the people in the three-or-more medication group were taking a benzodiazepine, such as lorazepam, which is marketed as Ativan, for anxiety or agitation, two common symptoms in people with dementia.
In addition, 32% of the people in the study group were taking an opioid such as hydrocodone, despite warnings against combining it with other drugs that affect the central nervous system.
Among the study participants, 14% were taking three or more drugs that act on the central nervous system, and had been taking them for more than a month.
Those with reduced cognitive abilities may be especially sensitive to potential risks associated with taking these medications in combination, as both aging and dementia can cause changes in brain chemistry that may alter their reactions to these drugs, the researchers said.
“It appears that we have a lot of people on a lot of medications without a very good reason,” Maust said.
“It’s important for family members and providers to communicate often about what symptoms are happening, and what might be done with non-medication interventions such as physical therapy or sleep hygiene, as well as medications, to address them,” he said.
“Educating loved ones who are caregivers about non-pharmacological approaches to managing agitation, psychotic symptoms and depression is also important,” he said.
“Physicians who care for older patients should build a medication review into every patient visit to make sure each patient gets the correct, and minimum number of, medications needed to manage their physical, mental and emotional health,” he added.