Dementia or Alzheimer’s What’s the Difference?
Living in denial can have long-lasting effects. About 12 years ago my disabled mother who has dystonia, a neurological movement disorder characterized by sustained or intermittent muscle contractions causing abnormal, often repetitive, movements, postures, or both, began behaving peculiarly.
Because of our complicated relationship, initially it was a little difficult to determine exactly the cause of my mother’s issues. Granted, on the nerve-wracking scale she could take me from zero to 1,000 in 0.01 seconds on a good day, however the length of time between these good days became increasingly shorter.
Poor judgement, cloudy thinking, and extreme agitation were only the tips of the iceberg. When it got to the point where my mother began relocating numerous times for reasons that defied logic and making irrational phone calls to landlords, friends and family members at all hours of the day and night I consulted with her neurologist and primary care doctor.
I thought, by working with my mother’s doctors we could get ahead of what was causing her bizarre behaviors. Due to some of the medications she was taking for her dystonia the doctors felt that an adjustment might be in order to help alleviate some of her symptoms of dementia. The way it was explained to me was that the dementia (a form of Alzheimer’s) was linked to her dystonia.
All in the Family
After gathering all the information I needed from my mother’s doctors and talking at great length with my aunt (her sister) it was time to have a serious talk. I was so prepared for this important sit-down but when I broached the subject of dementia with my mother she angrily put on her blinders and refused further discussion on the topic.
Nineteen years ago my grandmother (my mother’s mother) died from Alzheimer’s disease. This was the reason for my mother’s visceral reaction to me even whispering the word dementia. Though a change in her medication might not have been a cure, the doctors felt it would at least delay progression of the dementia but my hands were tied.
When my grandmother was diagnosed with Alzheimer’s it was, but in hindsight shouldn’t have been, a shock to the family. Even though she would continually say she felt she had the disease I would poo-poo it and tell her things like “oh grandma all you need to do is exercise your brain by doing crossword puzzles, reading, etc.” I felt so awful about my response to her genuine concerns and wished with all my heart that I could make it go away – I so wanted to protect her.
What’s in Your Medicine Cabinet?
Dictionary.com defines anticholinergics as a substance that opposes the effects of acetylcholine; interfering with the passage of parasympathetic nerve impulses. On January 25, 2015 the results of study looking at the effects of anticholinergic drugs and dementia was published online. Here is the link to the study: JAMA Internal Medicine.
Lucky me, Benadryl, an anticholinergic drug, was the prescribed treatment for my chronically severe hives. They appeared out of nowhere and took me completely by surprise because I had only seen hives once before on one of my sons.
Before I got the official diagnosis from my dermatologist my doctors weren’t sure what was going on with me as these huge purple blotches were only on my legs. Among other things, they thought it could be lyme disease but they were puzzled that it was restricted to my legs and it wouldn’t go away.
Thankfully the results of the biopsy confirmed the rash was chronic hives with no known reason and the only way to keep them under control was through the use of Benadryl taken at night. Since an outbreak could last for weeks or months on end (I’d get a new outbreak on stopping the Benadryl) I remained on it for years.
So imagine my concern when I read an article about certain allergy medications (anticholinergics) being linked to dementia and Alzheimer’s. The article, Common Sleep and Allergy Medications Linked to Dementia, Alzheimer’s, by Elizabeth Agnvall speaks to increased risks of dementia, including Alzheimer’s disease, associated with long-term use of certain over the counter medications.
Anticholinergic drugs include some antihistamines, tricyclic antidepressants, like doxepin (Sinequan), medications to control overactive bladder, for example oxybutynin (Ditropan), and drugs to relieve the symptoms of Parkinson’s disease. It was initially believed that memory issues were reversible when using these medications but now it appears that the damage to the brain from their usage may be permanent. Dementia and Alzheimer’s disease aside, if I knew that these medications could have a lasting effect on my memory I would have looked at alternatives.
The article talks about the risks associated with long-term use of the medications in older adults though it isn’t clear what older means. Is it over 50, 60, 70 or 80? Even so, if there is evidence of brain damage to older adults because of these drugs what does this mean for younger adults and children?
After doing a bit of research I found a list of anticholinergic drugs ranked on a scale of 1 to 3 with 3 being the ones to avoid. Here is the link to the anticholinergic cognitive burden scale developed by Malaz Boustani, Indiana University School of Medicine geriatrician in 2008.
I take a very different approach from my mother as it relates to dementia and Alzheimer’s. Since studies suggest certain risk factors such as age, family history and genetics and now anticholinergic drugs can play a role in who might get the disease, I will not operate with the “head in the sand” philosophy. The key word for me is proactive.
While the information from the study is disturbing it makes sense for us to be our own health care advocates by periodically reviewing the medications we are taking for the long haul and then follow-up with our doctors. Great care should also be taken when using any kind of over the counter medication.
“We remember their love when they can no longer remember.”