Higher Dementia Risk Linked To More Use Of Common Drugs
UW School of Pharmacy Professor Shelly Gray
Dr. Shelly Gray et. al. found a persistent link between dementia and some medications in a University of Washington/Group Health study published in JAMA Internal Medicine on January 26, 2015. The large study links a significantly increased risk for developing dementia, including Alzheimers disease, to taking commonly used medications with anticholinergic effects at higher doses or for a longer time. Many older people take these medications, which include nonprescription diphenhydramine . JAMA Internal Medicine published the report, called Cumulative Use of Strong Anticholinergic Medications and Incident Dementia.
The study used more rigorous methods, longer follow-up , and better assessment of medication use via pharmacy records to confirm this previously reported link. It is the first study to show a dose response: linking more risk for developing dementia to higher use of anticholinergic medications. And it is also the first to suggest that dementia risk linked to anticholinergic medications may persistand may not be reversible even years after people stop taking these drugs.
Some ACT participants agree to have their brains autopsied after they die. That will make it possible to follow up this research by examining whether participants who took anticholinergic medications have more Alzheimers-related pathology in their brains compared to nonusers.
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When To Steer Clear
Certain people should be more cautious about melatonin use, particularly if it triggers a negative reaction, including those with:
- Chronic insomnia. Having trouble falling asleep or staying asleep that lasts a month or more shouldn’t be managed with melatonin, according to the American Academy of Sleep Medicine and the American College of Physicians. These groups recommend other more proven remedies , noting that there is not enough evidence that melatonin is safe and effective for long-term use.
- Restless Legs Syndrome . The tingling or “creepy-crawly” feeling in the legs that often keeps people awake could be worsened by melatonin. The supplement can intensify RLS symptoms because it lowers the amount of dopamine in the brain, according to the Restless Legs Syndrome Foundation. If you’ve been diagnosed with RLS or suspect that you have the condition, talk to your HCP about lifestyle changes or medications that could help.
- Dementia. This progressive cognitive deterioration is often associated with insomnia, which can tax both patients and their caregivers. But melatonin may do more harm than good among those with dementia since the condition causes people to metabolize the supplement more slowly, resulting in daytime drowsiness. In people with moderate or severe dementia, melatonin supplementation may increase the risk of falls, according to 2015 guidelines from the American Academy of Sleep Medicine.
If you’ve been drinking alcohol, it’s also not safe to take melatonin.
Will Sleeping Pill With Diphenhydramine Lead To Memory Loss
Do you ever forget the names of people you should remember? What about dates like birthdays or anniversaries? How about pass codes? Is it just a benign senior moment, or something more insidious? Memory loss can be a natural part of aging, a sign of something more serious or even a side effect of a medication.
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The Relationship Between Dementia And Sleep
Sleep and dementia is a complicated topic. Different types of dementia are associated with different sleep problems. Researchers are also not yet sure which way the interaction goes – whether poor sleep causes or exacerbates dementia or if dementia leads to poor sleep. Some researchers believe that both of these theories could be true, and the relationship could be circular.
On top of this, it is unclear what the mechanisms are that underlie these interactions.
It is clear that more research is needed to understand this relationship in particular research that observes large groups of affected people for very long periods of time.
Dementia research volunteering
Melatonin Levels In Alzheimers Disease
Several studies have showed that melatonin levels are diminished in AD patients compared to age-matched control subjects . CSF melatonin levels decrease even in preclinical stages when the patients do not manifest any cognitive impairment , suggesting that the reduction in melatonin is an early marker for the first stages of AD .
The reduction in nocturnal melatonin levels with the abolition of diurnal melatonin rhythmicity can be the consequence of dysfunction of noradrenergic regulation and depletion of the melatonin precursor serotonin as already seen in the earliest preclinical AD stages . Alternatively, changes in the pathways of light transmission, from physical properties of the dioptric apparatus to a defective retinohypothalamic tract or suprachiasmatic nuclei -pineal connections have been discussed as possible reasons for the decline in amplitude of the melatonin rhythm and the corresponding changes in the circadian system . One should, however, be aware that light is inhibitory to the pineal, so that dysfunction in the transmission of light signals would not easily explain a decrease in melatonin. In any case, it is clear that the changes in melatonin secretion contribute to the frequent symptoms of sleep disruption, nightly restlessness and sundowning seen in AD patients.
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Taking Melatonin When Pregnant
Taking melatonin during pregnancy might help protect the babys brain against damage. However, there is not enough available evidence to confirm this benefit.
A 2016 review of studies did not find any evidence that taking melatonin during pregnancy has protective effects on a fetus.
When it comes to promoting sleep, melatonin may not be the best choice during pregnancy. It might interfere with the sleep cycles of the woman and the baby.
Although melatonin is safe overall, there is not enough research on its effects during pregnancy. Women who are pregnant or thinking about getting pregnant should talk to their doctor before taking this supplement.
Adverse Effects Of Melatonin Intake: Overview
Consumption of food supplements that contain melatonin or mainly contain melatonin has shown adverse effects in numerous studies. The most frequently reported side effects include headaches, dizziness, drowsiness, tremors, migraine, nausea, vomiting, abdominal pain, nightmares, vivid dreams, and irritability. There were even cases of supplement abuse for suicide attempts through melatonin overdose.
The reason for such adverse effects was traced to an incorrect presentation of the amount of melatonin a bottle of supplements truly contains. Investigation shows that melatonin supplement bottles can have 4 times more melatonin than indicated. This can affect ones health significantly, because of the higher the dose, the serious and more frequent side effects.
However, this is not the only reason side effects occur. Sometimes, doctors do NOT prescribe a suitable dosage, or the patients decide to dose themselves as they want. Some people even tend to drink alcohol with melatonin, hoping to emphasize the sedative effects. But, they just cause even more serious side effects.
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A Collaborative Effort To Improve Memory Problems:
Here is a link to an expanded list of anticholinergic drugs. You may wish to bring it to your doctors attention.
Please let us know how you make out. You are not the only one to report that too many anticholinergic drugs can affect memory. Here are some comments from visitors to this website:
Donna in North Carolina shares a concern several others have also expressed:
Atarax and Benadryl were routinely administered in the chemotherapy I received for breast cancer. After 5 months of chemo, I attributed my loss of mental function to a condition I read about called chemo brain and chalked it up as another price paid in side affects for the benefit of staying alive.
Because these two drugs were dispensed so often and so casually, I have taken them both since chemo, especially Benadryl, because I am allergic to certain insect bites, and because it can aid in sleep. The big-gun cancer drugs have caused organ damage, aging organs 20-25 yrs, Id say. It may be that the anticholinergics are responsible for the most frustrating loss I have experienced! I remember reading about taking choline back in the 1970s and wonder if that would be helpful for my memory.
Aurie in Michigan offers an interesting observation:
Derborah in Brooklyn, MD:
To see a list of drugs that are potentially problematic for senior citizens, check out our Guide to Drugs and Older People in our Health Guides.
How To Increase Melatonin Levels Naturally
Luckily, you can increase your melatonin levels without supplementing.
A few hours before bedtime, simply dim all lights at home and avoid watching TV and using your computer or smartphone.
Too much artificial light can reduce the production of melatonin in the brain, making it harder for you to fall asleep .
You can also strengthen your sleep-wake cycle by exposing yourself to plenty of natural light during the day, especially in the morning .
Other factors that have been associated with lower natural melatonin levels include stress and shift work.
Summary Fortunately, you can increase your natural melatonin production naturally by sticking to a regular sleep schedule and avoiding artificial light late in the evening.
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What Is Sleep Disordered Breathing
Sleep disordered breathing is when someone has difficulty breathing when they are asleep. This may be because of obstructions to the airway, making breathing harder work. Sleep disordered breathing is sometimes called sleep apnoea. People of all ages can be affected by sleep disordered breathing, but it is most common in older people and people with obesity. Some research has suggested that people who are affected by sleep disordered breathing may be at higher risk of cognitive decline or impairment. This is because sleep disordered breathing may cause damage to the brain due to changes of levels of oxygen and carbon dioxide in the blood. It may also change flow of blood to the brain.
Dementia Connect support line
Melatonin Based Therapies For Delirium And Dementia
Institution: Division of Geriatric Medicine, Department of Medicine, University of AlbertaAddress: Edmonton, Alberta, T6G 2G3, Canada
Abstract: Melatonin levels have been shown to decline with aging. Melatonin and its analogs in addition to their effect on sleep promotion, has been shown to have multiple pleiotropic effects. It can also help with neuroprotection through different mechanisms. Evidence in animal and human studies suggests that low levels of melatonin have been linked to delirium, mild cognitive impairment, dementia, and with certain behavioral problems. Recent clinical trials have showed that both melatonin and its analogs may be useful in the prevention, treatment of delirium, and the management of dementia. These medications seem to have the advantage of less side effects and better safety profile when compared to antipsychotics and sedatives like benzodiazepines. These medications are available over the counter in North America, Europe, and Asia, and some of these medications are approved by FDA. This manuscript will discuss the promising role of these melatonergic medications alone or in combination with other medications for the management of geriatric psychiatric diseases like delirium and dementia.
Melatonin Physiology and Biological Effects
Pharmacology of Melatonin and Melatonergic Drugs
Melatonin serum levels
Table 1. Changes in melatonin levels with aging.
Melatonin Dosage For Adults
Its also possible to take a melatonin supplement if it is more convenient to do so.
There are currently no official guidelines relating to a suitable melatonin dosage for adults or children,
so it is advised to carefully follow any manufacturers instructions when taking food supplements.
Melatonin for Alzheimers Disease has primarily been tested with a melatonin dosage of 3mg, 6mg, and 9mg given daily before bed,
all of which have been found to significantly improve classic symptoms of dementia.
Is Melatonin Safe?
One of the benefits of melatonin is that it is a natural hormone, and therefore it is considered to be very safe.
However, there are some minor melatonin side effects to be aware of, including dizziness, headaches, nausea, and fatigue.
While generally safe, melatonin does have known interactions with some common medications,
so melatonin should not be taken if youre on an anti-depressant, anti-psychotic, or anti-anxiety medications,
along with blood thinning or steroid-based medications.
This is because melatonin may reduce the efficacy of these medications.
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How To Supplement With Melatonin
To aid sleep, the standard dosage ranges from 1 to 10 milligrams per day. However, the optimal dose has not been formally established .
Since not all melatonin supplements are the same, make sure to follow the instructions on the label.
Also, keep in mind that the quality of over-the-counter supplements is not monitored by health authorities. Try to choose brands that are reputable and certified by a third party, such as Informed Choice and NSF International.
Many experts do not recommend their use in children and adolescents until more evidence confirms its safety in these groups .
Since melatonin is transferred into breast milk, breastfeeding mothers should keep in mind that it might cause excessive daytime sleepiness in nursing infants .
The common dosage of melatonin ranges from 110 mg per day, but make sure to follow the instructions on the label. Parents should not give it to their children without first consulting their medical provider.
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Other Possible Melatonin Side Effects
- Melatonin and birth control effects melatonin supplements may not be safe for women trying to get pregnant. It seems that melatonin has similar effects as birth control, making it more difficult for women to reach ovulation and become pregnant. Some evidence shows that lower doses, up to 3mg are safe, but there is not enough research to prove that.
- Melatonin and bleeding disorders it is believed that regular melatonin intake can worsen the symptoms and effects of bleeding disorders. Studies show that melatonin may slow blood clotting or coagulation, which may lead to excessive bleeding and bruising.
- Melatonin and epilepsy studies and current data show that melatonin can trigger or worsen epilepsy and seizure frequency in some people. While some experts argue otherwise, some professionals do not recommend melatonin intake in people who are prone to having epileptic or other types of seizures not even small doses.
- Melatonin and transplant recipients because melatonin can increase the immune function, it might interfere with immunosuppressive therapy used by transplant recipients.
Is It Habit Forming
According to the National Sleep Foundation, experts do not believe that melatonin is addictive on a short term basis. Unlike other sleep medicines, it does not cause symptoms of withdrawal when people stop using it.
However, scientists need to carry out more long-term research to confirm that this sleep aid is not habit-forming.
Some people do become dependent on melatonin to sleep. They may find that when they stop taking this supplement, they have a harder time falling asleep.
As with any supplement, people need to check with their doctor before they take melatonin. Getting advice from a doctor can help prevent avoid adverse effects, dependency, and possible interactions between melatonin and other medications.
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Melatonin Limits Stroke Damage
Once a stroke has begun to develop, melatonin can prevent the death of neurons in the stroke arealimiting the damage done by the stroke.11 Researchers conducted an experiment in which they removed the pineal glands of rats to make them deficient in melatonin. They found that these rats experienced significantly greater brain damage after a stroke or seizure than the rats that still had sufficient melatonin levels.43
Repeated animal studies have demonstrated that animals supplemented with melatonin prior to a stroke experienced a decrease in the volume of brain tissue affected by an ischemic stroke .11,44-47 This results in improved neurological and behavioral outcomes, and faster recovery from the stroke.11,47,48
One of the most important determinants of a good recovery from a stroke is the degree of plasticity in the surviving neurons.49 Plasticity involves how well the surviving neurons are able to shift their function and take on some of the activities of damaged or destroyed brain cells. 49 Melatonin has been found to increase the plasticity of the neurons on both sides of the brain an effect that hastens recovery.50
A Safer Alternative to Prescription Sleep Drugs
Melatonins Role In Neurodegenerative Diseases
Some scientists think the increase in neurodegenerative diseases as we age may be directly related to the age-related decline in melatonin levels.2-4 Fortunately, oral melatonin supplements are available, which may combat this decline by increasing blood and brain levels of melatonin.6,7
Supplementation with low-cost melatonin thus offers an opportunity to restore the brains natural antioxidant protection and potentially prevent age-related changes to the brain.2,4,6,16,17 In fact, melatonins effects are so powerful that its been designated a drug by the European Medicines Agency .17
With the onset of menopause, animals experience a marked increase in oxidative damage, leading to brain cell dysfunction.18 Studies show that in such animals, melatonin supplementation reverses those harmful effects in a similar manner to hormone replacementbut without the associated risks.18
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Additional Steps To Improve Sleep
People with sleeping problems can benefit from taking steps to develop healthy sleep habits. Even if melatonin offers relief, improving their sleep routines and environment known collectively as sleep hygiene can promote durable sleep quality improvement.
Talking with a doctor about melatonin and sleeping problems can also help reveal whether a person has an underlying sleep disorder. For example, raising poor sleep issues or excessive sleepiness may uncover a problem like sleep apnea. Melatonin isnt a therapy for sleep apnea, but in this scenario, working with the doctor can lead to more appropriate and effective treatments.