This article was previously published on August 1, 2019 and has been updated with new information.
According to the statistics for 2019,first 14% of Americans age 71 and older have some form of dementia. Alzheimer’s disease, the most severe and deadly form of dementia, affects about 5.8 million Americans. Among them, 81% are over 75 years old, but about 200,000 are younger than 65 years old. 1 in 10 elderly people over the age of 65 have dementia.
Due to the high rate of dementia and the scarcity of effective conventional treatments, prevention is paramount. I have written numerous articles on the subject, highlighting some of the most important prevention strategies, including dietary recommendations and the need for exercise, sun exposure, and avoidance of toxic.
A less-noticed risk factor is medication side effects, which we’ll focus on here. A group of drugs of great interest in this regard are anticholinergics – drugs that block acetylcholine, a neurotransmitter that performs important functions in the brain, peripheral and central nervous systems.
In your nervous system, it acts as both an activator and an inhibitor,2 that is part of the reason why it is used in so many medicines. For example, acetylcholine triggers muscle contractions and response to pain, and is involved in regulating your endocrine system and REM sleep cycle.
In your brain, it plays an important role in attention, concentration,3,4 memory formation and consolidation,5 which is why these drugs can cause dementia-like symptoms.
Acetylcholine Blockers May Trigger Dementia Symptoms
Anticholinergics are prescribed for a variety of conditions, including depression, urinary incontinence, diarrhea, dizziness, motion sickness, insomnia, allergies, and epilepsy.6,7 You can find a long list of anticholinergics and the different conditions they’re used for on Seniorlist.com.8 As reported in a July 2019 article on KHN.org:9
“By all accounts, the woman, in her late 60s, appeared to have severe dementia. She was largely incoherent. Her short-term memory was terrible. She was not. can focus on the questions that health professionals ask.
But Dr. Malaz Boustani, a professor of aging studies at Indiana University School of Medicine, suspects something else may be going on. The patient was taking Benadryl for seasonal allergies, another antihistamine for itching, Seroquel (an antipsychotic) for mood swings, as well as medications for urinary incontinence. host and digestive disorders.
To varying degrees, each of these drugs blocks an important chemical messenger in the brain, acetylcholine. Boustani thinks the cumulative effect could be causing the woman’s cognitive difficulties. He was right.”
When the patient was discontinued from these drugs for a period of six months, she made what appeared to be a “miracle” recovery; Her score on the Mini Mental State Test went from showing severe dementia back to normal.
Anticholinergics Outstanding Risk Study
A June 2019 studyten in the JAMA that assessed the dementia risk associated with different anticholinergic drugs found the strongest association for:
- Antidepressants (tricyclic antidepressants such as imipramine,11 doxepine or amitriptyline have strong anticholinergic effects, while SSRIs such as citalopram and duloxetine have lower anticholinergic effectstwelfth)
- Antiparkinson drug
- Antipsychotics (such as clozapine,13 chlorpromazine or olanzapine14)
- Bladder pain relievers (such as oxybutynin or tolterodine,15 prescription for overactive bladder)
- Anticonvulsants (such as oxcarbazepine or carbamazepine)16)
A case-control study17 published in 2018 in the BMJ, like the JAMA study just mentioned, which looked at the effects of different anticholinergic drugs, also found that antidepressants, diuretics, and antiarkinsons pose a risk tallest.
Similarly, an earlier study,18 Published in JAMA Internal Medicine in 2015, found that “Higher cumulative anticholinergic use is associated with increased risk of dementia,” including Alzheimer’s disease, and that anticholinergic use should be minimized. cholinergic to avoid the risks associated with this drug.
Overall, heavy use of anticholinergics for three years or more was associated with a 54% increased risk of dementia compared with no use.19 Furthermore, they concluded that this increased risk persisted even after the drug or drugs were discontinued.
According to KHN,20 A new trial will look further into this, to see if patients taking anticholinergics whose cognition has already begun to decline can restore their brain function, or if the drug’s effects have an effect. more permanent or not.
Many over-the-counter medications have anticholinergic effects
Importantly, anticholinergics are not just prescribed. Many common over-the-counter medications also contain anticholinergic ingredients. Including21 antihistamines sold under the brand names Benadryl and Chlor-Trimeton, sleep aids such as Tylenol PM, Aleve PM and Unisom, motion sickness drugs Dramamine, and various cold medicines.22
In the case of Benadryl and many sleep aids, the anticholinergic ingredient in question is diphenhydramine. In Chlor-Trimeton it’s chlorpheniramine; in many cold medicines, it is pyrilamine.23
Because there are so many different drug components that have anticholinergic effects, it can be somewhat difficult to identify them, making it possible to use more than one anticholinergic agent simultaneously. The end result can be severe dementia-like symptoms, like those experienced by Boustani’s patients.
So, for your own safety, take the time to research all the medications you take regularly or even semi-regularly, including OTC drugs, to identify those that have anticholinergic effects. Don’t assume your doctor will monitor this or warn you about the dangers of anticholinergics. As noted by KHN:24
“‘Physicians generally assume that anticholinergic symptoms in the elderly are due to aging or age-related disease rather than to the effects of drugs,’ according to one research review25 by doctors at the Medical University of South Carolina and in the UK. “
Unfortunately, drug side effects are rarely suspected when new symptoms appear, which is why it’s important to do your research and know what these possible side effects are. what.
You can find a list of anticholinergic ingredients used in antihistamines, antiarrhythmics, antidepressants, urinary incontinence, antipsychotics, antispasmodics, and antispasmodics. antiemetics at the bottom of the Drugs.com “Anticholinergics to Avoid in the Elderly” page.26
Importance of Choline for Dementia Prevention
Choline27 is a precursor to acetylcholine and is an essential nutrient not only for your brain and nervous system, but also for your cardiovascular function. The Institute of Medicine officially recognized choline as an essential nutrient for human health in 1998.28
Aided by a carrier protein, choline combines with acetyl coenzyme A at the nerve cell terminals to form the neurotransmitter acetylcholine. There must always be enough choline in your brain for your nerve cells to function properly.29 Choline has also been shown to protect against Alzheimer’s disease by:30
- Lower your levels of homocysteine, an amino acid that has been shown to be neurodegenerative and linked to the formation of amyloid plaques, two telltale signs of Alzheimer’s disease. Choline converts homocysteine to methionine, which has a number of beneficial effects.
- Inhibits microglia activation. Microglia cells clear debris from your brain, and while this is an important function, in Alzheimer’s disease, microglia tend to become overactive, causing inflammation in the brain that can can lead to nerve cell death. By reducing the activation of microglia, choline may help protect Alzheimer’s patients from further brain damage.
Other Health Benefits of Choline
Choline is also involved in the synthesis of phospholipids necessary for healthy cell structure. The most common phospholipid is phosphatidylcholine, or lecithin, which makes up 40% to 50% of your cell membranes.thirty first Choline is also required for:32
- Mitochondrial function – A 2014 study33 choline was found to be important for healthy mitochondrial membranes in liver cells, and one animal study34 published in 2010 also reported that a choline-deficient diet impairs cognition and motor coordination by causing mitochondrial dysfunction in the brain. As the authors note, their findings “emphasize that, like the liver, the brain needs an adequate supply of choline to function properly.”
- The fetus is developing healthy35 – Choline is needed for proper neural tube closure,36 healthy brain and vision development.37 Research shows that mothers who get enough choline give their children a lifelong memory boost due to changes in the development of the hippocampus (memory center) in the baby’s brain.38
- Epigenetic regulation of gene expression – As explained in a 2013 article,39 “Diet of methyl donors such as choline affects DNA and histone methylation, thereby altering the epigenetic regulation of gene expression.”
- Fat transport and metabolism – Choline is needed to transport cholesterol from your liver; Choline deficiency can lead to excess fat and cholesterol accumulation leading to fatty liver disease.40,41
Studies have linked higher choline intake to a range of benefits, including a reduced risk of dying from heart disease,42 24% reduced risk of breast cancer,43 and prevent non-alcoholic fatty liver disease (NAFLD).44,45,forty six
In fact, choline appears to be a major controlling factor in the development of fatty liver, as it enhances the excretion of very low-density lipoprotein (VLDL) particles in your liver, which in turn is essential for safely transport fat out of the liver.47 The study also uncovered evidence for an epigenetic mechanism of choline,48 This also helps explain how choline helps maintain healthy liver function.
Do You Have Enough Choline to Protect Your Health?
While a dietary reference intake value has yet to be established for choline, the Institute of Medicine has set the “adequate daily intake” value at 550 milligrams per day for adult men and 425 mg for grown woman.49 to prevent liver damage.
However, keep in mind that requirements can vary widely, depending on your overall diet, age, ethnicity.50 and genetic makeup.51 Pregnant and lactating women, athletes, and postmenopausal women often need higher amounts, and eating a diet high in (if not healthy) saturated fat can also increase your needs. your choline bridge.52
The tolerable upper choline level is 3.5 grams per day. Side effects of too much choline include low blood pressure, sweating, diarrhea, and a fishy body odor.53
Eggs are the main dietary source of choline; with 115 mg of choline per egg yolk,54 They are an easy way to ensure completeness. Other healthy sources of choline55 Includes organic grass-fed beef (kidney and liver) beef, organic chicken or turkey. Supplements, including krill oil, are another option if you’re concerned about getting enough choline from your diet.
