- Experts say that elderly people with dementia should limit the number of drugs they take that act on the brain and central nervous system (CNS).
- The use of three or more medications together puts the individual at greater risk of adverse outcomes.
- One study found that almost 1 in 7 elderly people with dementia who do not live in a nursing home take three or more of these drugs.
- The study examines the prescriptions that doctors have prescribed for 1.2 million people with dementia.
Experts are clear that people aged 65 and over should not simultaneously take three or more drugs that target the brain or the CNS.
These drugs often interact, potentially accelerating cognitive decline and increasing the risk of injury and death.
This guidance is especially relevant for people with dementia, who often take various medications to treat their symptoms.
A recent study of people with dementia found that almost 1 in 7 of the participants is taking three or more drugs for the brain and the CNS, despite warnings from experts.
Although the United States government regulates the distribution of such drugs in nursing homes, there is no equivalent supervision for individuals living at home or in assisted living. The recent study focused on individuals with dementia who do not live in nursing homes.
The study’s lead author, geriatric psychiatrist Dr. Donovan Maust of the University of Michigan (UM) at Ann Arbor, explains how an individual can end up taking too many medications:
“Dementia comes with many behavioral problems, from changes in sleep and depression to apathy and withdrawal, and health professionals, patients and caregivers can naturally try to resolve this with medication.
Dr. Maust expresses concern that doctors prescribe too many drugs too often. “It seems like we have a lot of people taking a lot of drugs for no good reason,” he says.
The study article appears in JAMA.
For the study, UM researchers examined the prescription of sleeping pills, antipsychotics, antidepressants, opioid painkillers and anticonvulsant drugs for nearly 1.2 million people with dementia, using their 2018 Medicare records.
While younger people can safely use these drugs together, the concern is that age-related changes and dementia in brain chemistry may result in undesirable interactions.
Of the people in the study, 13.9% took three or more CNS-related drugs for more than 1 month, which the study authors describe as “active polypharmacy in the CNS”.
Prescriptions for these drugs were common, with 831,017 individuals having received at least one of the drugs at least once during the year. Almost half of those studied – 535,180 – took one or two of these drugs for more than 1 month.
In the polypharmacy group active in the CNS, 92% took the most commonly prescribed class of drugs: antidepressants.
Anticonvulsant medications were also common, with 62% of participants in the active polypharmacy group in the CNS taking them. Gabapentin (Neurontin), a medicine for epilepsy, dominated this category, with its prescribed use representing a third of every day in the study period. The study authors suggest that it is the well-known off-label use of the drug to control pain and anxiety.
About 41% of the active polypharmacy group in the CNS also had prescriptions for benzodiazepines, such as lorazepam (Ativan).
A significant number of people who took three or more CNS medications in the study (47%) took antipsychotics.
Antipsychotics are not among the drugs approved for dementia, but doctors can prescribe them, says Dr. Maust, to help control restlessness, sleep problems and other problems. The antipsychotic most frequently prescribed in the study was quetiapine (Seroquel).
Dr. Maust notes the need for doctors to present a compelling case for the simultaneous prescription of various drugs for the brain and the CNS. He says that “the evidence supporting the use of many of them in people with dementia is very little, although there is a lot of evidence about the risks, especially when there are multiple drugs layered on top of each other.”
Dr. Maust and his colleagues suggest that increased drug reviews by medical professionals can help identify negative interactions when people use three or more drugs for the brain and the CNS together.
The current lack of information on the use of these drugs in dementia it often leaves doctors in the position of having to make a difficult judgment.
Doctors sometimes write prescriptions, says Dr. Maust, hoping to help an individual control symptoms and thereby avoid the need for long-term care. Avoiding this care is a particular goal during the COVID-19 pandemic, as long-term care facilities have experienced high mortality rates.
Doctors can also prescribe medication to prevent family members from witnessing distressing behaviors in a loved one with dementia.
Dr. Maust suggests that families can have a broader role to play, helping to refine an individual’s treatment plan, keeping the doctor informed of any changes they witness in the person’s symptoms and behavior.
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