Anticholinergics

"Pills" by David K, via Flickr, Creative Commons 01/14/2017

"Pills" by David K, via Flickr, Creative Commons 01/14/2017

If you are elderly or advocating for someone who is, you should know the term anticholinergic. Anticholinergics are drugs which block the neurotransmitter acetylcholine. As neurotransmitters go, acetylcholine is a big player in the ability to form new memories. Most of us in the world of Alzheimer’s disease are familiar with the small handful of drugs currently available to treat it. Most of these drugs are aimed at increasing levels of acetylcholine, so it’s not a great leap of logic to assume that drugs which inhibit acetylcholine are potentially bad for the brain. Researchers publishing in the Journal of the American Geriatrics Society asserted much the same. This is the flatly stated conclusion in the article’s abstract: “The use of medications with anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.” None of that equivocal mumbo-jumbo we get sometimes from scientists squirming, not without reason, from absolutes. These drugs should be used with caution in the elderly. Period. 

I wish I had been better informed, when standing over my father when he was hospitalized with a broken back (see My Father and the Sea, Reflections), demanding that a geriatric neurologist oversee the plethora of medications he was being given. The hospitalist assigned to his case was dismissive. “Der is no such ting as a jellyatlick neurologist,” he chuckled, in heavily accented English. “Neurologists treat efreebootie. Dey all treat efreebootie. Young, old, meen, whimeen…”

I stared at him incredulously. I felt like saying “There may not be any in your country. Amazingly, we have them here in America.” But sarcasm, however tempting, would not have helped my father. I have the following suggestions for the adult children of elderly parents prone to serious falls that result in hospitalization: Make certain your parent has an established personal physician, preferably a geriatrician familiar with the effects of various drugs on memory loss. Write down current medications and keep the information in an easily accessible place. Make it your business to stay fully informed of what is being done to and with your loved one. You will not win a popularity contest at the hospital, but this will be the least of your worries.