A recent study of elderly nursing home patients that looked at the side effects of those who took medications for dementia—called cholinesterase inhibitors—and medications for incontinence—called anticholinergics—concurrently, experienced a 50 percent faster decline in function than those being treated for dementia only. The findings appear in the Journal of the American Geriatrics Society.
“Over a year’s time, the decline would represent a resident going from requiring only limited assistance in an activity to being completely dependent, or from requiring only supervision to requiring extensive assistance in an activity,” study chief Dr. Kaycee M. Sink, of Wake Forest University, Winston-Salem, North Carolina said in a university-issued statement. These two drug classes “cancel each other out should not be used in combination,” Sink added.
Sink and colleagues studied data on over 3,500 elderly nursing home residents who were taking cholinesterase inhibitors, drugs that increase levels of acetylcholine, a chemical that enhances communication between nerve cells in the brain. Examples of cholinesterase inhibitors include donepezil (Aricept), galantamine (Razadyne), rivastigmine (Exelon), and tacrine (Cognex). About 10 percent were also taking either oxybutynin (Ditropan) or tolterodine (Detrol). Ditropan and Detrol are the two most prescribed drugs for urinary incontinence, are known as anticholinergics, and are designed to block acetylcholine.
According to the research team, this drug combination affected older adults who started out with higher levels of function in routine activities of daily living (ADLs) such as dressing, personal hygiene, going to the bathroom, getting out of bed, eating, and being able to get around the nursing home. In those who initially were most capable of performing routine ADLs and were not taking the bladder drug, functioning declined by an average of 1.08 points per quarter, while in those who were taking both types, the decline in functioning was 1.62 points per quarter, a significant 50 percent decrease.
In addition to being prescribed for incontinence, anticholinergics are also commonly prescribed for the treatment of a variety of diseases and conditions, including acid reflux and Parkinson’s Disease. Earlier Wake Forest studies on which we have reported found that anticholinergic drugs alone may be adversely affecting the thinking skills of older patients, a phenomenon not observed in those patients studied who do not take these medications. The studies also indicate that anticholinergics may cause older patients to experience a decrease in their daily physical activities.
One of the earlier Wake Forest studies found that older adults taking anticholinergic medications became more likely to walk more slowly and required help in other daily activities. “These results were true even in older adults who have normal memory and thinking abilities,” said Sink. “For older adults taking a moderately anticholinergic medication, or two or more mildly anticholinergic medications, their function was similar to that of someone three to four years older.”
Alarmingly, an estimated 33 percent of people with dementia are also taking a medication to control incontinence. The two studies suggest that physicians should carefully consider the implications when prescribing anticholingeric medications to older adults.
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