The new dementia scare: brain health is the key

02/02/2015

Preserving brain health is the key and that starts with the brain cells

The newspapers never make for happy reading these days but when a report describing a link between dementia and some commonly used medications broke we had an influx of queries from worried individuals of all ages. True enough, the study was looking at the use of certain regularly used drugs in older people but the very fact that there did appear to be a link sent shock waves through communities of medication reliant people. The study was published in JAMA Internal Medicine this January and involved 3434 individuals aged 65 and over. The important thing to note here is the fact that none of these individuals exhibited any signs or symptoms of dementia at the start of the study, which lasted 2 years.

Over the study period it became apparent that medication belonging to a group known as anticholinergics appeared to be closely associated with a worrying trend, that of dementia symptoms in those people using that specific class of medication. The dementia-medication relationship was even dose related with those people using the higher doses being at greater risk. When the researchers looked closer at the data they also discovered that talking the minimum effective dose over extended periods of time had the same effect as taking a high dose of the medication. In other words, even a low dose taken over a prolonged time placed the person in the highest risk category and increased the risk of developing dementia!

Despite this study being an observational one, and by its very design unable prove the link or make categorical statements such as ‘anticholinergic drugs cause dementia’, the results do raise some real concerns and I for one would not fancy taking anticholinergic agents for an extended period of time!

Is there a safe amount of time when these drugs can be used?

While the dust settles on the actual implications of these findings it’s not a wise move to stop any medications that fall into this class of drugs before chatting it over with your doctor who may be able to offer reassurance or an alternative. It is also important to note that while this was an observed effect it was only noted in people who took anticholinergics daily for three years or more. Sadly, the study has opened more questions than it has answered and there is no agreement on what a safe level of an anticholinergic drug is in connection to prolonged use and its potential to increase dementia risk. Remember, even a low dose taken regularly over time pushed people into the highest risk category.

So, what exactly are anticholinergic agents?

In a nutshell, anticholinergic agents are drug compounds that block the neurotransmitter known as acetylcholine. Neurotransmitters are specific chemicals released by nerve ending that allow the various nerve fibres to ‘talk’ to each other. Out of interest, to date there have been over 100 different neurotransmitter chemicals identified with acetylcholine being the first to be identified back in 1915.  By blocking the actions of acetylcholine the anticholinergic agents exert effects on many body systems simply because the actions of acetylcholine touch so many aspects of the day-to-day functions of the body. In an attempt to make the effects of anticholinergic agents more specific a range of drugs have been developed to they are more tissue or organ specific but as you would expect, this is not without side effects. Anticholinergic agents are commonly taken for a variety of health problems but the most statistically significantly results in the current study involved the following prescribed medications (note: the list below details the actual drug name not a brand name);

• xybutynin chloride, 5mg
• chlorpheniramine maleate, 4mg
• olanzapine, 2.5mg
• meclizine hydrochloride, 25mg
• doxepin hydrochloride, 10mg

It is also worth noting that the US study mentioned the drug Benadryl by name as one implicated in the dementia scare. However, in the UK the Benadryl product contains a different compound compared to the US version, which contains diphenhydramine. Keeping with the antihistamine theme, newer versions of allergy medication often describe themselves as non-drowsy because they are not anticholinergic agents. Cetirizine, for example, of one such antihistamine that may be confused with older allergy medicines. Since certirizine has no anticholinergic effect is not implicated as posing a dementia risk.

Natural brain protectors

Looking on the positive side, there does appear to be some real help out there when it comes to preserving our mental facilities. Interestingly, caffeine can counteract the symptoms of anticholinergic drug use such as drowsiness by boosting the activity of acetylcholine by binding to specific regions of the nerve ending that normally get stimulated by a compound called adenosine. By blocking adenosine and attaching itself to adenosines receptor area caffeine enabled the additional release of extra acetylcholine thereby reversing drowsiness and enhancing memory and cognitive function. So long as you are not overly sensitive to the effects of caffeine a cup or two of coffee may actually offer some real benefit in battling the effects of ‘brain fog’ or cognitive decline.

Another natural agent with a less easy to remember name has been the focus of memory related research for many years. It is known as phosphatidylserine and it forms a vital component of the delicate membrane that surrounds all the cells of our brain, nervous system and body. Cell membranes are made up of fats known as phospho-lipids. This gives our cells flexibility, a vital factor in cellular health. The latest research in the field suggests that having a healthy cell membrane may hold the key to long-term brain health. Without this flexibility specialised processes that only occur within the walls of our cells simply can’t function. Many of these processes involve cell-to-cell communication using transmitter chemicals such as acetylcholine. If the cell membrane is ‘stiff’ and there is a lack of acetylcholine its fairly easy to see how basic functions such as cellular communication will start to fail. In the brain, this means a poor transmission of impulses and thoughts! In other words, our memory will fail if the brain cells can’t chat!

Phosphatidylserine plays a pivotal role in maintaining membrane flexibility and is thought to be a vital compound needed in the maintenance of memory and cognitive functions, possibly offsetting dementia. In fact, in 2003 the American FDA gave a qualified health claim status to phosphatidylserine that allowed labels to state that "consumption of phosphatidylserine may reduce the risk of dementia and cognitive dysfunction in the elderly". Despite the FDA also commenting that this claim was based on very limited and preliminary scientific research suggests that phosphatidylserine may reduce the risk of cognitive dysfunction in the elderly. However, what we do know is that phosphatidylserine can only support brain function in a positive way and in light of the latest news may be a useful natural agent in repairing brains exposed to these medications. Intake data published in 2002 about its use in elderly people has indicated that 200mg taken up to 3 times a day appear to be safe.

So, in conclusion, it may be wise to chat to your doctor if you are taking anticholinergic medication or have been taking them on a regular basis for 3 years or more, even at a low dose. In the mean time, may be consider taking some phosphatidylserine or a special blend of phosphatidylserine that is combined with EPA and DHA (fish oils) known as PS-IQ made by the Canadian Manufacturer Natural Factors, may be washed down by a nice cup of coffee!

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