Some of the most common prescription and over-the-counter medicines can produce side-effects with symptoms similar to those of dementia, glaucoma, and other diseases of old age.
Writing in the September 2000 issue of the British Journal of the Royal Society of Medicine, Dr Jacobo Mintzer of the Medical University of South Carolina, calls for "better understanding, assessment and management" of the problem to avoid elderly patients being given inappropriate treatments.
As well as dementia-like symptoms of confusion, memory loss, and disorientation, and glaucoma-like blurred vision, Dr Mintzer mentions potential side-effects which mimic other 'old age' conditions. These can include dry mouth, constipation, urinary problems, dizziness, likelihood of falling, anxiety, rapid shallow breathing, and irregular or rapid heartbeat. Many illnesses like angina and diabetes, as well as glaucoma and dementia, "are all worsened" by this group of medicines.
Any drugs with 'anticholinergic activity' can have these side-effects. Many of the prescription drugs used in the treatment of Parkinson's disease, depression, allergies, migraine, and irritable bowel syndrome (IBS), fall into this category, as do some pain relieving drugs. Meanwhile, non-prescription drugs of this type are becoming increasingly available, including cold and flu medicines, indigestion tablets, sleeping pills and anti-diarrhoea treatments. The risk of side-effects from a dose of one of these might be very small, but many elderly patients take several kinds of medications at once, increasing the likelihood of 'anticholinergic load'.
Elderly patients in nursing homes are most at risk, warns Dr Mintzer. Some reports suggest that 60% of nursing home residents will have received drugs from the anticholinergic group in the past year, compared with 23% of elderly people in the community. Doctors may assume that any side-effects are an inevitable part of the ageing process rather than something which could be avoided by altering existing medication regimes. The elderly are also more likely to be at risk from anticholinergic load, not only from a variety of medications but because their metabolism is often less efficient, allowing drugs to stay longer in their system.
Dr Mintzer recommends:
Comment from PSPInformation
It has been known since before 1992 that the symptoms of Parkinson's disease, Alzheimer's disease and PSP are mostly caused by an unbalance of the chemical transmitters that enable the brain to communicate.
In Parkinson's disease the problem is a shortage of dopamine which causes the shaking and jerkiness.
In Alzheimer's there is sufficient dopamine but a shortage of acetylcholine.
With PSP we seem to have a shortage of both of these plus a shortage of a neurotransmitter called GABA.
We don't know why these shortages occur. It's one of the many unknowns about these diseases.
Medications for these (and other) diseases largely have the objective of creating a better neurotransmitter balance. As one example, many medications given for Parkinson's disease do not try to increase dopamine - instead they try to block the action of acetylcholine which would tend to create a "balance". These are called "cholinergic blocking" or "anticholinergic" substances.
Many medications, both prescription and non-prescription work by blocking the action of acetylcholine including antihistamines, cold remedies, dopamine agonists, antidepressants etc. It is very easy for the effect of these medications to "add up" if several are taken, for various reasons, at the same time.
Another problem is that the ability of elderly persons (especially those who are sick) to neutralize and remove medications from the body slows. This too can cause a build up of these substances.
The problem is so serious that other articles on PSPInformation relate that cholinergic blocking medications should not be used by the elderly unless absolutely necessary. And even then they should be discontinued as soon as possible.
In the previous paragraphs we are talking about the elderly who appear to have "normal" amounts of acetylcholine, not persons who already have too little.
Since those with PSP already have a shortage of acetylcholine and other neurotransmitters, it would appear that the use of these medications would "block" the usefulness of the acetylcholine that remains. This, in turn would worsen the neurotransmitter balance and probably cause additional long-term permanent harm.
