- Experts believe that older adults with dementia should limit the number of medications they take that act on the brain and central nervous system (CNS).
- By using three or more such medications together, an individual may be at greater risk for adverse effects.
- A study found that nearly 1 in 7 elderly people with dementia who do not live in a nursing home use three or more of these medications.
- The study examines the prescriptions that doctors have written for 1.2 million people with dementia.
Experts are clear that people aged 65 and older should not take three or more brain- or CNS-targeted medicines at the same time.
Such drugs often interact, potentially accelerating cognitive decline and increasing the risk of injury and death.
This guide is especially relevant for people with dementia, who often use various pharmaceuticals to address their symptoms.
A recent study involving people with dementia found that nearly 1 in 7 of the participants took three or more medications for the brain and CNS, despite warnings from experts.
While the United States government regulates the supply of such medicines in nursing homes, there is no similar supervision for individuals living at home or in assisted living facilities. The recent study focused on individuals with dementia who do not live in nursing homes.
The lead author of the study, geriatric psychiatrist, Dr. Donovan Maust, of the University of Michigan (UM) in Ann Arbor, explains how an individual can eventually take too much medication:
“Dementia comes with many behavioral problems, from changes in sleep and depression to apathy and withdrawal, and providers, patients and caregivers can, of course, try to address it through medication.”
Dr Maust expresses his concern that doctors are prescribing too much medicine. “It turns out that a lot of people have a lot of medicine without very good reasons,” he says.
The study paper appears in JAMA.
For the study, researchers from UM examined the prescription of sleeping pills, antipsychotics, antidepressants, opioid painkillers and anti-seizures for nearly 1.2 million people with dementia.
Although younger people can use this drug safely, the concern is that changes in brain chemistry with age and dementia are associated with unwanted interactions.
Of the people in the study, 13.9% took three or more CNS-related medications for more than 1 month, which the study authors describe as “CNS-active poly-pharmacy.”
Prescriptions for this drug were common, and 831,017 individuals received one of the drugs at least once during the year. Nearly half of those studied – 535,180 – took one or two of these medications for more than 1 month.
In the CNS-active polypharmacy group, 92% used the most prescribed medication: antidepressants.
Anti-seizure medications were also common, with 62% of those in the CNS-active polypharmacy group. Gabapentin (Neurontin), a drug for epilepsy, dominated this category, with its prescribed use for a third of all days in the study period. The authors of the study suggest that it is known for using the drug to control pain and anxiety.
About 41% of the CNS-active poly-pharmacy group also have prescriptions for benzodiazepines, such as lorazepam (Ativan).
A significant number of people using three or more CNS drugs in the study (47%) used antipsychotics.
Antipsychotics are not one of the approved drugs for dementia, but doctors can prescribe them, says Dr. Maust, to help manage anxiety, sleep problems and other problems. The most commonly prescribed antipsychotic drug in the study was quetiapine (Seroquel).
Dr Maust notes that doctors need to make a compelling case for the simultaneous prescribing of multiple medicines for brains and CNS. He states that ‘the evidence supporting the use of many of these in people with dementia is quite thin, while there is a lot of evidence about the risks, especially if several medicines have been laid on top of each other.’
Dr Maust and his colleagues suggest that increased drug reviews by medical professionals may identify negative interactions when people use three or more brain and CNS drugs together.
The current lack of information on the use of these drugs in dementia often leaves doctors in the position of having to make a difficult judgment.
Doctors sometimes prescribe, says Dr. Maust, hoping to help an individual cope with symptoms and thus avoid the need for long-term care. Avoidance of this care is a particular goal during the COVID-19 pandemic, as long-term facilities experienced a high mortality rate.
Doctors may also prescribe medication to prevent family members from experiencing bad behavior in a loved one with dementia.
Dr. Maust suggests that families can play an extensive role in refining an individual’s treatment plan by keeping the physician informed of the changes they see in the person’s symptoms and behavior.
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