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Wednesday 14 January 2015

Dementia, Alzheimer's disease and links with Anticholinergic drugs

Anticholinergic drugs are used to treat a variety of ailments, including gastrointestinal conditions such as nausea, vomiting, gastritis, diarrhoea, diverticulitis, ulcerative colitis; respiratory disorders such as asthma, bronchitis, and COPD; and other conditions, such as cystitis, urethritis, prostatitis, insomnia and dizziness.

There are many kinds and brands of Anticholinergetic drugs, and it has been estimated that about 50% of the USA population is taking at least one of these drugs.This list has been taken from the Wikipedia website (used here, but not always the best, or most accurate source of health information because of its connections with the conventional medical establishment).

Anti-Muscarinic Drugs. Atropine, Benztropine (Cogentin), Biperiden, Chlorpheniramine (Chlor-Trimeton), Dicyclomine (Dicycloverine), Dimenhydrinate (Dramamine), Diphenhydramine (Benadryl, Sominex, Advil PM, etc.), Doxylamine (Unisom), Glycopyrrolate (Robinul), Hydroxyzine (Atarax, Vistaril), Ipratropium (Atrovent), Orphenadrine, Oxitropium (Oxivent), Oxybutynin (Ditropan, Driptane, Lyrinel XL), Tolterodine (Detrol, Detrusitol), Tiotropium (Spiriva), Trihexyphenidyl, Scopolamine, Solifenacin, Tropicamide. 

Anti-Nicotinic Drugs. Bupropion (Zyban, Wellbutrin), Ganglion blockers; Dextromethorphan, (Cough suppressant and ganglion blocker), Doxacurium (Nondeplorizing skeletal muscular relaxant), Hexamethonium, (Ganglion blocker), Mecamylamine, (Ganglion blocker and occasional smoking cessation aid), Tubocurarine, (Nondepolarizing skeletal muscular relaxant).

Known (Disease Inducing Effects)
It is important to note that Anticholinergetic drugs are widely implicated in causing dementia and Alzheimer’s disease. Wikipedia lists the following side-effects for these drugs, and included amongst these can be found many pointers to these diseases of the mind. The article states that long-term use of these drugs increases the risk of both mental and physical decline.

Ataxia; loss of coordination
Decreased mucus production in the nose and throat; consequent dry, sore throat
Xerostomia or dry-mouth with possible acceleration of dental caries
Cessation of perspiration; consequent decreased epidermal thermal dissipation leading to warm, blotchy, or red skin
Increased body temperature
Pupil dilation (mydriasis); consequent sensitivity to bright light (photophobia)
Loss of accommodation (loss of focusing ability, blurred vision – cycloplegia)
Double-vision (diplopia)
Increased heart rate (tachycardia)
Tendency to be easily startled
Urinary retention
Diminished bowel movement, sometimes ileus (decreases motility via the vagus nerve)
Increased intraocular pressure; dangerous for people with narrow-angle glaucoma.

Possible effects in the central nervous system:
Euphoria or dysphoria
Respiratory depression
Memory problems[7]
Inability to concentrate
Wandering thoughts; inability to sustain a train of thought
Incoherent speech
Mental confusion (brain fog)
Wakeful myoclonic jerking
Unusual sensitivity to sudden sounds
Illogical thinking
Visual disturbances
Periodic flashes of light
Periodic changes in visual field
Visual snow
Restricted or "tunnel vision"
Visual, auditory, or other sensory hallucinations
Warping or waving of surfaces and edges
Textured surfaces
"Dancing" lines; "spiders", insects; form constants
Lifelike objects indistinguishable from reality
Phantom smoking
Hallucinated presence of people not actually there
Rarely: seizures, coma, and death
Orthostatic hypotension (sudden dropping of systolic blood pressure when standing up suddenly) and significantly increased risk of falls in the elderly population.[8]

The Wikipedia article says that it is ‘unclear’ whether they affect the risk of death! Research done by the University of East Anglia in 2011 appears to give some clarification on this, and confirmation of the association between Anticholinergetic drugs. They found that a ‘side-effect’ of many commonly used drugs increased the risks of both cognitive impairment and death in older people. This research was described as the first systematic investigation into the long term health impacts of anticholinergic drugs, and its findings were published by the Journal of the American Geriatrics Society.

They found that the anticholinergic drugs with the greatest effect, taken frequently by older people, were: 
  • Anti-depressants such as Amitriptyline, Imipramine and Clomipramine
  • Tranquilisers such as Chlorpromazine and Trifluoperazine
  • Bladder medication such as Oxybutynin
  • Antihistamines such as Chlorphenamine. 
Other drugs with an anticholinergic effect mentioned were Atenolol, Furosemide and Nifedipine for heart problems; painkillers such as Codeine and Dextropropoxyphene; the asthma treatment Beclometasone; and the epilepsy treatment Carbamazepine; and Timolol eyedrops which are used for glaucoma. 

More than 13,000 men and women aged 65 and over from across the UK were included in the two-year study. Around half were found to use a medication with potential anticholinergic properties. The key findings were:

• 20% of participants taking drugs with a total ACB of four or more had died by the end of the two-year study, compared with only seven per cent of those taking no anticholinergic drugs - the first time a link between anticholinergics and mortality has been shown. 
  • For every additional ACB point scored, the odds of dying increased by 26%.
• Participants taking drugs with a combined ACB of five or more scored more than 4% lower in a cognitive function test than those taking no anticholinergic medications “confirming evidence from previous smaller studies of a link between anticholinergics and cognitive impairment”. 
• The increased risks from anticholinergic drugs were shown to be cumulative, based on the number of anticholinergic drugs taken and the strength of each drug’s anticholinergic effect. 
• Those who were older, of lower social class, and with a greater number of health conditions, tended to take the most anticholinergic drugs.

Such are the dangers of this category of pharmaceutical drug there has even been a disease named after it - Anticholinergic Syndrome!