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 LA Times article on anticholinergics + a list 
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post LA Times article on anticholinergics + a list
Hopefully you all are aware of the potential side effects of anticholinergic medication -- particularly important to know about for the elderly and for those with dementia. There was a good Los Angeles Times article on this topic last week. It's copied below along with a link to the article.

Mentioned in the article is a resource that I've never heard of before but looks like it would be very promising: it's a list of the "anticholinergic cognitive burden" of anticholinergic medications. You can find it here:
http://www.indydiscoverynetwork.org/Ant ... Scale.html



http://www.latimes.com/news/health/la-h ... 7679.story

Medicines from class of drugs commonly used by the elderly, including Benadryl and Dramamine, can cause impaired thinking, study finds

Thomas H. Maugh II, Los Angeles Times
4:05 PM PDT, July 13, 2010

The family of drugs that includes the over-the-counter medications Benadryl, Dramamine, Excedrin PM, Sominex and Tylenol PM can double the risk of impaired thinking in elderly African Americans, and presumably in Caucasians as well, researchers said Tuesday.

The family, called anticholinergics, blocks the activity of the neurotransmitter acetylchoine, and also includes the prescription drugs Paxil, Detrol, Demerol and Elavil. Most of the anticholinergics are used by the elderly to aid sleep and to relieve bladder leakage problems. The drugs have previously been shown to increase the risk of delirium as well. Delirium is a form of sudden-onset cognitive impairment.

Blacks are already known to be at high risk for cognitive impairment, one reason that researchers focused specifically on them. The team, led by Dr. Malaz Boustani of the Regenstrief Institute at the Indiana University School of Medicine, took advantage of an ongoing study called the Indianapolis Ibadan Dementia Project, whose aim is to compare risk factors for dementia in blacks in Indianapolis and Yoruba in Ibadan, Nigeria. The new study involved 1,652 Indianapolis blacks who did not suffer cognitive impairment when they entered the study. Researchers collected information from participants about their use of the drugs, and also collected medicine bottles from their homes during each assessment. They found that 11% of the subjects used anticholinergics.

After six years of follow-up, the team reported in the journal Neurology, patients taking one anticholinergic were 46% more likely to suffer from cognitive impairment, while those taking two were twice as likely. The risk was somewhat higher in the patients who did not carry what is known as the E4 variant of the gene APOE, which plays a role in the metabolism of triglycerides, a form of cholesterol. That finding was somewhat surprising because APOE E4 increases the risk of Alzheimer's disease.

"Simply put, we have confirmed that anticholinergics, something as seemingly benign as a medication for inability to get a good night's sleep or for motion sickness, can cause or worsen cognitive impairment, specifically long-term mild cognitive impairment which involves gradual memory loss," Boustani said in a statement. "I tell all my [elderly] patients not to take these drugs….Our research efforts will now focus on whether anticholinergic-induced cognitive impairment may be reversible."

A list of medications with anticholinergic effects can be found here.

Copyright © 2010, The Los Angeles Times


Wed Jul 21, 2010 1:46 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: LA Times article on anticholinergics + a list
Thank you, Robin. That linked list of anticholinergics is very helpful. I'm saving it for sure. And scary! Consider all the LBD patients who take Seroquel, for instance! Do you think doctors ever look at this list? Or will look at it? My husband's doctors, including his neurologists, have tried to prescribe several of the drugs on the 'definite' list before I pointed out, diplomatically, that he couldn't take those drugs.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Wed Jul 21, 2010 2:33 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: LA Times article on anticholinergics + a list
I'm quite sure everyone in the local Lewy Body Dementia support group who has seen quetiapine (Seroquel) on this list is concerned today. There are so many different lists out there and no agreed-upon approach for weighing anticholinergic burden, that I wouldn't get too concerned about Seroquel being on this list. For Seroquel in particular, there is general agreement among LBD-savvy and PD-savvy MDs that it's the first-choice antipsychotic for this patient population (along with Clozaril, which has some associated blood test requirements). In other words, I'd place far more weight on my neurologist's opinion than the opinion of the Indy Discovery Network.


Wed Jul 21, 2010 6:11 pm
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Joined: Wed Dec 30, 2009 1:46 pm
Posts: 3213
Location: WA
Post Re: LA Times article on anticholinergics + a list
Plus the fact that they have Haldol as an 'alternative' [inpatient setting]. Of course, this list is for geriatric patients in general, not LBD. But the fact that some see Haldol as a safer alternative gives me pause.

_________________
Pat [68] married to Derek [84] for 38 years; husband dx PDD/LBD 2005, probably began 2002 or earlier; late stage and in a SNF as of January 2011. Hospitalized 11/2/2013 and discharged to home Hospice. Passed away at home on 11/9/2013.


Wed Jul 21, 2010 6:53 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: LA Times article on anticholinergics + a list
I think the only MD-generated list of anticholinergics (mostly) we have specific to LBD is the Van Gerpen list, which was posted here a couple of years ago.


Wed Jul 21, 2010 7:06 pm
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Joined: Fri Aug 11, 2006 1:46 pm
Posts: 4811
Location: SF Bay Area (Northern CA)
Post Re: LA Times article on anticholinergics + a list
See Dr. Jay Van Gerpen's list here:
viewtopic.php?f=4&t=1589


Wed Jul 21, 2010 7:09 pm
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