James Pickett, head of research at Alzheimer’s Society, says that, given that AF is more common as people get older, it’s important that any links with the risk of dementia are fully investigated. “We know that atrial fibrillation can increase the risk of having a stroke by up to five times if left untreated,” he says. “Given that having a stroke is also a risk factor for developing dementia, it isn’t surprising to see that people with this condition are more likely to develop dementia.
Bunch adds that because the risks associated with anticoagulants are still not fully understood, only patients that absolutely need them should be placed on them long term.
Researchers say study is the first to show dementia risk in warfarin-treated patients regardless of indication.
“In patients who have very stable and predictable levels of warfarin these data are reassuring as dementia rates are very low,” says Bunch. “In people who have very erratic [warfarin] levels then alternatives such as a direct oral anticoagulant or a non-pharmacologic approach may be preferable for their long-term management.”
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The researchers then matched 6,030 patients based on baseline characteristics. In this comparison, they found the overall risk of dementia increased 2.4-fold among AF patients. The risk of Alzheimer’s disease was increased by 2-fold and the rate of vascular dementia 2.5-fold.
Corresponding author Kirsty Oswald
Among the best-recognized cognitively dangerous medications are those with anticholinergic properties. This means that the medications block the effect of acetylcholine, an important brain chemical and neurotransmitter that becomes less plentiful in the aging brain. These medications have an impact on brain cells by occupying its receptor molecules, and can help people gain relief from symptoms of insomnia, irritable bowel syndrome, or several other medical conditions. Also, many medications valued for their other effects have incidental anticholinergic properties. Among the clinically significant anticholinergic medications are medications such as tolteridine, often used to treat urinary incontinence. In addition, some antidepressants (especially the tricyclics such as amitriptyline), antipsychotics, cardiac medications, antispasmodics, antivertigo medications, and antiparkinsonian medications have anticholinergic effects.
Cognitive changes associated with anticancer chemotherapeutic agents is now a well-documented condition that affects some, though not all, patients treated with these medications. “Chemo brain” affects attention, working memory, and executive function and sometimes leaves lasting changes.
Medications are so helpful in treating infections, cancer, high blood pressure, endocrine problems, and psychiatric conditions among other diseases. They can provide amazing benefits for symptoms of pain, fever, inflammation, and insomnia, just to name a few. Yet no medication, not even a placebo pill, is free of side effects. And when the side effects interfere with attention, memory, language, executive function, or other cognitive faculties, an examining clinician might incorrectly suspect the presence of a progressive dementia. Many medications have been shown to cause or are suspected of causing cognitive symptoms (see the table below for examples). In this article, I’ll describe some of the most common medications linked with cognitive symptoms and describe their effects.
Benzodiazepines, a class of medications used to treat anxiety or insomnia, comprise another group that has been linked with cognitive difficulties. Although these medications are truly a blessing for some individuals immobilized by anxiety, their use can be accompanied by sedation and mental slowing. A recent study even suggested that prolonged use of benzodiazepines might be a risk factor for later dementia, although experts have questioned the significance of this finding and clinicians continue to prescribe anti-anxiety medications such as lorazepam (Ativan) or sleeping pills such as temazepam (Restoril) and consider them very beneficial when used properly.
Pain-relieving medications, particularly the opioids, are important and valuable when used properly. Their deleterious effects on short-term memory have been investigated and recognized. Pain relief is a necessity, of course, and proper use of pain-relievers is important. Their cognitive effects, like the other medications here, are reversible after the medications are stopped.