Caring for a loved one with dementia presents a host of challenges for families and caregivers. From ensuring safety, hygiene and proper nutrition to overcoming communication and behavioral difficulties, caring for a person with dementia can be daunting and requires much diligence, energy and, of course, patience.
It also requires a basic knowledge of how some common medicines can make symptoms of dementia worse. For example, when a loved one with dementia is suffering from a cold, the flu or an allergy, your instinct may be to administer a common over-the-counter medicine to provide some relief, but that may very well lead to larger problems.
"Generally, older people are much more susceptible to the negative side effects of both over-the-counter and prescription medications," says Dr. Michael Plopper, chief medical officer for Sharp Behavioral Health Services. "And those with dementia or Alzheimer's disease are particularly vulnerable because they already have structural or ongoing degenerative changes in their brain, chiefly with acetylcholine, an organic chemical that operates as a neurotransmitter to play an important role in memory and attention."
Dr. Plopper says there are some standout culprits, such as antihistamines, found in common medications that interfere with acetylcholine, which can exacerbate memory and cognitive issues, and cause other problems including dizziness and loss of balance.
"If a person with dementia is given an over-the-counter cold or allergy medication that contains an antihistamine, it's very important to closely monitor the individual and discontinue use if negative side effects occur," he says. "This is definitely a serious concern for seniors, especially those with cognitive issues, which can sometimes be overlooked."
According to Dr. Plopper, another major problem is associated with prescription medications for seniors, most problematically sedative-hypnotics, such as alprazolam (Xanax), and sleep medications, which can lead to excessive sedation and also cause balance and cognitive issues. Individuals can also build up a tolerance to these drugs and experience serious withdrawal symptoms if they are suddenly discontinued due to an unexpected hospitalization for other health issues, which can complicate matters.
"Additionally, seniors normally experience decreased liver and kidney function; gain fat and lose muscle; and also have less free water in their bodies," says Dr. Plopper. "These physiological changes affect how long drugs stay in the body, how they concentrate in the blood stream and are stored in body fat, and explain why seniors are more prone to the negative side effects of medications. Again, these complications are often amplified in seniors with dementia, Alzheimer's, and other memory and cognitive disorders."
Dr. Plopper recommends the following tips for better medication management for seniors and those with dementia:
- Talk to your loved one's primary care doctor before administering any cold or allergy medication
- Keep a complete and accurate list of medications and supplements, and share that list with all doctors who provide care for your loved one
- Older persons should be on as few medications as possible, so periodically review the medications list with the doctor to see what can come off the list
- Ensure that any antipsychotics are prescribed in low doses because they can be toxic for seniors