Study, Feb/19: Drug interactions w dementia-related pathophysiological pathways

Journal: British Journal of Pharmacology

Full title: Drug interactions with dementia-related pathophysiological pathways worsen or prevent dementia.

Abstract

Many risk factors are known to induce or precipitate dementia. Drugs acting via different mechanisms can modulate cognitive performance and exert either beneficial or deleterious effects on cognition through functional or neuropathological mechanisms. This review discusses the association between several classes of drugs and cognitive impairment and dementia risk. These drugs can be dichotomized into drugs targeting central nervous system disorders (e.g., anticholinergic drugs, antiepileptics, antipsychotics, benzodiazepines, and opioids) and drugs targeting non-central nervous system disorders (e.g., antidiabetics, antihypertensives, proton pump inhibitors, and statins). Furthermore, we sought to highlight the pharmacological mechanisms underlying their possible detrimental or beneficial effects on cognition. Anticholinergic and antiepileptic drugs were excluded from this review knowing that their effects on cognition are well known. Studies investigating benzodiazepines have revealed an increased risk of dementia. Conclusions on dementia risk or cognitive impairment regarding opioids and antipsychotic drugs are difficult to draw. These different classes appear to impair cognition not by an unambiguous mechanism of action specific to each class but by several relatively interdependent and interconnected mechanisms (e.g., impaired neurotransmission, neuroinflammation, neuronal death, oxidative stress or interactions with dementia-related pathways). The dementia risk initially associated with the use of proton pump inhibitors might have been overestimated. In contrast, statins, antihypertensive medications and antidiabetics could potentially decrease the risk of dementia and cognitive impairment by acting in ways opposite to the mechanisms cited above.

https://www.ncbi.nlm.nih.gov/pubmed/30714122

Thanks for posting this.

“Studies investigating benzodiazepines have revealed an increased risk of dementia.”

This is a very controversial subject!

Thanks for posting this.

 

“Studies investigating benzodiazepines have revealed an increased risk of dementia.”

 

This is a very controversial subject!

Glad it was helpful.  I didn't know it was controversial and have seen it mentioned several times.  My understanding is that it's been shown there's an association between development of dementia in older adults and long-term benzo use.

Here's one article looking into this link:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5118753/

Hi seltzerer,

Yes, thanks for posting this one. Indeed, with regards to benzos and dementia, the evidence is still controversial. We've seen many, many studies on this one, but no absolutely conclusive evidence. It's hard to prove because there are numerous confounding factors.

Hi seltzerer,

Yes, thanks for posting this one. Indeed, with regards to benzos and dementia, the evidence is still controversial. We've seen many, many studies on this one, but no absolutely conclusive evidence. It's hard to prove because there are numerous confounding factors.

Yes, association but no causation. How about cognitive side effects and falls/injuries? Are those less controversial?

Yes, much less. It seems to me that those things are listed in all of the medical literature as potential side effects from benzodiazepines. It's just that there's still much that's not understood about dementia and Alzheimer's -- e.g. what causes it, how long the preamble is to people actually showing signs and symptoms, how to treat it, etc.

Also, anxiety and insomnia often seem to be part of the picture, but no one seems to be able to say whether that's a result of having the disease or part of the actual disease process. And, of course, if people present with anxiety and insomnia, they're often prescribed benzodiazepines.

So many confounding factors.