Occasional periods of forgetfulness or "brain fog" where you can’t think clearly or have trouble multitasking and comprehending information is an unfortunate sign of aging. But you may not know that some over-the-counter and prescription drugs can affect your memory and cognitive function too.
1. Sleeping aids (nonbenzodiazepine sedative-hypnotics)
Why they are prescribed: Sometimes called the “Z” drugs, these medications can be used to treat insomnia and other sleep problems. They also are prescribed for mild anxiety.
Examples: Eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien).
How they can affect memory: Although these are molecularly distinct from benzodiazepines (see No. 1, above), they act on many of the same brain pathways and chemical messengers, producing similar side effects and problems with addiction and withdrawal. The “Z” drugs also can cause amnesia and sometimes trigger dangerous or strange behaviors, such as cooking a meal or driving a car with no recollection of the event upon awakening.
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Alternatives: There are alternative drug and nondrug treatments for insomnia and anxiety, so talk with your health care professional about options. Melatonin, for instance, can help to reestablish healthy sleep patterns. And cognitive behavioral therapy for insomnia (CBT-I) is the first-line treatment for the sleep disorder.
Before stopping or reducing the dosage of these sleeping aids, be sure to consult your health care provider. Sudden withdrawal can cause serious side effects, so a health professional should always monitor the process.
2. Incontinence drugs (anticholinergics)
Why they are prescribed: These medications are used to relieve symptoms of overactive bladder and reduce episodes of urge incontinence, an urge to urinate so sudden and strong that you often can’t get to a bathroom in time.
Examples: Darifenacin (Enablex), oxybutynin (Ditropan XL), solifenacin (Vesicare), tolterodine (Detrol) and trospium (Sanctura). Another oxybutynin product, Oxytrol for Women, is sold over the counter.
How they can affect memory: Patients who take anticholinergics can have complications with their long-term memory, says Merrey. These medications have been associated with an increased risk of dementia, and that heightened risk can persist even after the medication has been discontinued.
That’s because these drugs block the action of acetylcholine, a neurotransmitter that mediates all sorts of functions in the body. In the bladder, anticholinergics prevent involuntary contractions of the muscles that control urine flow. In the brain, they inhibit activity in the memory and learning centers. The risk of memory loss is heightened when the drugs are taken for more than a short time or used with other anticholinergic drugs.
Older adults are particularly vulnerable to the other adverse effects of anticholinergic drugs, including constipation (which, in turn, can cause urinary incontinence), blurred vision, dizziness, anxiety, depression and hallucinations.
Alternatives: As a first step, it’s important to make sure that you have been properly diagnosed. Check with your doctor or other health professional to see if your urinary incontinence symptoms might stem from another condition (such as a bladder infection or another form of incontinence) or a medication (such as a blood pressure drug, diuretic or muscle relaxant).
Once these are ruled out, try some simple lifestyle changes, such as cutting back on caffeinated and alcoholic beverages, drinking less before bedtime and doing exercises to strengthen the pelvic muscles that help control urination.
Some urologists are treating overactive bladder with Botox injections to help the muscle relax. Solutions beyond the medicine aisle can also come in handy. “I’ve been really thrilled with the improvements in protective [undergarment] items. They’ve really come a long way,” says K. Ashley Garling-Nañez, clinical assistant professor at the University of Texas at Austin College of Pharmacy. “There are a lot more options for active adults.”
3. Cholesterol-Lowering Drugs
There have been several studies that claim statins and other high cholesterol busters may impair memory by lowering cholesterol levels in the brain as well as in the blood. Lipids in the blood are essential in the formation of connections between nerve cells, which underlie memory and learning.
The FDA warns that some people may experience memory loss or confusion while taking statins, a type of cholesterol-lowering drug. However, the evidence is conflicting, and some studies have found that statins have no effect on memory. For example, a 2015 study found that people who take any type of cholesterol drug are almost four times more likely to report memory loss right after starting the drug, but it also compared people who didn't take cholesterol drugs to those who did. A 2003 review of case reports and literature found that about 50% of patients reported cognitive side effects within two months of taking statins, but 56% of those patients saw improvements when they stopped taking the drug.
In 2012, the FDA modified the labels for statins to reflect their increased risk for memory problems.
What You Can Do: Be sure to tell your doctor of any noticeable changes you see after taking your medication
4. Narcotic painkillers (opioids)
Why they are prescribed: These medications are sometimes used to relieve moderate to severe pain from surgery or injuries. In some instances, they can also be used to treat chronic pain.
Examples: Fentanyl (available as a patch), hydrocodone (Vicodin), hydromorphone (Dilaudid, Exalgo), morphine and oxycodone (Oxycontin). These drugs come in many different forms, including tablets, solutions for injection, transdermal patches and suppositories.
How they can affect memory: These drugs work by stemming the flow of pain signals within the central nervous system and by blunting one’s emotional reaction to pain. Both these actions are mediated by chemical messengers that are also involved in many aspects of cognition, so use of these drugs can interfere with long- and short-term memory, especially when used for extended periods of time. Researchers have also found a link between opioid use and dementia in older adults.
Alternatives: In patients under the age of 50 years, nonsteroidal anti-inflammatory drugs (NSAIDs) are the frontline therapy for pain. Unfortunately, NSAID therapy is less appropriate for older patients, who have a much higher risk of gastrointestinal bleeding. Research shows the risk goes up with the dosage and duration of treatment.
Acetaminophen (Tylenol) may be another option, but again, it’s important to consult your doctor about risks, side effects and drug interactions for all medications.
5. Antianxiety drugs (benzodiazepines)
Why they are prescribed: Benzodiazepines are used to treat a variety of anxiety disorders, agitation, seizures, and delirium and muscle spasms. Because benzodiazepines have a sedative effect, they are sometimes used to treat insomnia and the anxiety that can accompany depression.
Examples: Alprazolam (Xanax), chlordiazepoxide, clonazepam (Klonopin), diazepam (Valium), flurazepam, lorazepam (Ativan), midazolam, quazepam (Doral), temazepam (Restoril) and triazolam (Halcion).
How they can affect memory: Benzodiazepines dampen activity in key parts of the brain, including those involved in the transfer of events from short-term to long-term memory. In fact, they’re used in anesthesia for this very reason.
Alternatives: Benzodiazepines should be prescribed only rarely in older adults, and then only for short periods of time. It takes older people much longer than younger people to flush these drugs out of their bodies, and the ensuing buildup puts older adults at higher risk for not just memory loss but delirium, falls, fractures and motor vehicle accidents. Another drawback: They’re addicting, says D.P. Devanand, M.D., professor of psychiatry and neurology at Columbia University Medical Center.
Talk with your doctor or other health care professional about treating your condition with other types of drugs or nondrug treatments. If you are taking these medications for insomnia, for instance, the first line of treatment is cognitive behavioral therapy for insomnia (CBT-I). And an antidepressant might be able to treat your anxiety, Devanand notes.
Be sure to consult your health care professional before stopping or reducing the dosage of any benzodiazepine. Sudden withdrawal can trigger serious side effects, so a health professional should always monitor the process.
