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Medicines That Affect Your Memory
Dr. Lynsey Brandt discusses medicines that affect your memory.
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Learn more about Lynsey Brandt, MD, PharmD
Lynsey Brandt, MD, PharmD
Dr. Brandt specializes in geriatric medicine with additional interests in graduate medical education and faculty development. She joined Christiana Care Health System from the Perelman School of Medicine at the University of Pennsylvania, where she was an assistant professor of clinical medicine. Dr. Brandt is board-certified in Internal Medicine and Geriatric Medicine.Learn more about Lynsey Brandt, MD, PharmD
Transcription:
Melanie Cole (Host): Welcome to ChristianaCare’s Swank Memory Care Podcast series. I’m Melanie Cole and today, we’re talking about medicines that affect your memory. Our speakers in this podcast series represent the Swank Center for Memory Care and Geriatrics, Delaware’s first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia or other neurocognitive disorders. Joining me is Dr. Lynsey Brandt. She’s an Associate Medical Director at the Swank Center for Memory Care and Geriatric Consultation at ChristianaCare. Dr. Brandt, thank you so much for being with us today. First before we get into the medications that can affect our memory, tell us a little bit about your unique background.
Lynsey Brandt, MD, PharmD (Guest): Well thank you for having me and thank you for asking. So, my background is a bit unique as you said. I was originally trained as a pharmacist before I decided to go to medical school. And I recall working in the pharmacy and feeling a little bit removed from my patients and wanted to be a little more directly involved in their care and in their lives and so I took that background and applied that in my medical training and have carried that through into my profession here in geriatric medicine.
Host: That’s so interesting and it’s such an interesting profession that you’re in. So, when a patient experiences significant memory loss, it’s important they seek a medical evaluation obviously to evaluate for potentially modifiable lifestyle or medicational causes of their changes in memory. Tell us how medications can cause changes in memory or clarity of thought.
Dr. Brandt: Absolutely. So, when people come to see me, and they are experiencing a change in their memory, I am charged with looking for underlying causes that we could potentially modify and to help them do better. So, as you stated, medications are one of the major categories that we focus on during tis evaluation. Medications can affect one’s clarity of thought or even their memory directly by the way the medication works in the body. For example, some medications are called anticholinergic medications and these medicines oppose the chemical in our body that help us to remember things. Also, medications can interact with other medicines that someone is taking. So, for instance, you could be using one medicine and it might affect the metabolism of another medicine such that both of them maybe hang around longer in the body or give more affect than either of them would individually.
And finally, patients can also have effects from stopping a medication. So, if it’s something they’re supposed to be taking everyday and they abruptly discontinue it, that might also give them some changes in their memory or their behavior or their clarity of thought.
Host: Well thank you for that explanation Dr. Brandt. So, the aging body handles medications differently which can increase a person’s risk of experiencing these side effects such as memory loss. Do we have any risk factors for this? Do we know about an individual’s risk of a medication causing memory issues?
Dr. Brandt: Yes so, as you alluded to, the changes in our body happen almost universally, naturally as we age. For instance, our kidney function is something that declines with age. And as you may know, certain medications are cleared from the body through the kidneys. So, for example, a patient could be taking a medication called, I’ll use an example specific, gabapentin is one example of something that can be taken for a number of reasons. Often, it’s used for nerve pain or neuropathy. This medication is cleared out from the body through the kidneys. And so, as our kidney function slows down, the level of gabapentin in the body could build up and hang around longer and result in side effects such as confusion, drowsiness, dizziness, or even forgetfulness.
Other things that happen as we get older are changes in our body composition. We have less water and more fat in our systems and some of the medications that distribute into the fatty tissues also might hang around longer. For example, a medicine like Valium if you have ever heard of that, could once a person takes a dose of Valium, could be in their system for many, many days and really have a lasting effect on their memory.
Host: Well thank you again for that. So, let’s talk about besides the ones that you’ve mentioned, gabapentin and Valium, categories of medications. Are there some that are more likely to cause problems when we’re talking maybe sleep meds, because there’s a lot of those and anxiety or antidepressants, stomachaches. There’s so many medications out there that can cause issues. Tell us about some of them.
Dr. Brandt: Now the first thing I will say, I always give a disclaimer when I’m presenting this information for folks. If at some point, I name a medication and it’s something that someone listening here is taking, I don’t want to insight panic. Because in any given patient, the medicine might be the right thing for that particular patient. So, just because it might be on my list of concerning medicines here, perhaps that is the right choice for someone. And I also want to also encourage people that if again, you hear of a medicine here, that I mention is a concern, I wouldn’t want you to stop that abruptly. I’d encourage the patient to discuss it with their medical provider and decide whether it’s something that they want to maybe taper off of or wean off gradually.
With that being said as you said, one of the ones we look at almost universally would be sleeping medications. So, both over-the-counter or prescription. People commonly use something called diphenhydramine. That’s in a lot of sleep aids. It’s sometimes combined also with other pain medicines. So, like acetaminophen and diphenhydramine or naproxen and diphenhydramine. Those are pain medicines with the sleeping medicine can absolutely cause people to be more forgetful and not only that, more off balance and at risk of falling.
Other medicines would be anxiety or nerve pills. Earlier I mentioned the word Valium, the generic name is actually diazepam. So, nerve pills like diazepam, lorazepam can cause people to be forgetful, disoriented, maybe even hallucinate. In addition to just being really drowsy and maybe even a little depressed.
Other medicines we would worry about would be pain medications, usually the narcotics so something like morphine, or oxycodone or even codeine. And then other ones that people might not suspect as much so commonly I see people on medicines for stomach pain or irritable bowel. An example would be something called dicyclomine there’s a common name of Bentyl for that medicine. Notice I’m giving you mostly generic names because we try to speak in the generic drug names. Also medicine for bladder control. Something called oxybutynin is a common one or tolterodine. These medicines while they are good in that they help with the bladder control problem, or the one that I mentioned earlier, the stomach issues; they also tend to cause forgetfulness. They are all in that category of what I called anticholinergic medications, and which can really impact the memory and clarity of thought.
Host: Such a good explanation of the different classes of medications Dr. Brandt. So, how can a patient and you mentioned not to freak out about it, but how can a patient and provider consider those risks and the benefits and what should they discuss and as you said, not to panic about it, if someone does learn that they are taking a medication which can affect their memory, it’s important that they don’t stop abruptly but tell us about the discussion between a physician and the patient on these medications that might affect their memory.
Dr. Brandt: Absolutely. So, I spend a lot of time in my practice exploring what the underlying cause is for the reason a patient might be using one of these medicines. Let’s take sleep as an example. So, sleeping pills are commonly used by many people. We spend a lot of time looking at what is the difficulty with the sleep? For instance, is someone drinking a lot caffeine? Is there a way we can modify that behavior? Or is someone say napping a lot during the day in which case they’re going to be more awake at night. Are there behaviors and other nonpharmacologic things that we can modify in their life that might make the need for a sleeping medication less? So, that’s the first and foremost.
Another example would be anxiety. Again, there are a lot of other medication options or nonpharmacologic things we could do for anxiety. Counseling, meditation, exercise, those sort of things. and then once we – it takes a lot of partnering I would say with the patient and the provider. These patients have to trust us because oftentimes they’ve been on these medicines for years and we have to say look, this is another way that we could approach this. Do you trust me? Do you want to move forward and partner together? Knowing that this is I think a two way conversation and I want the patients to feel like they have some ownership so that they can give me feedback on maybe gradually reducing the medication and implementing some of those other lifestyle type changes.
I often use the analogy also in geriatrics of it’s more of a dimmer switch rather than an on off switch. So, I do a lot of kind of dialing back slowly and I think whenever we gradually make these changes, presuming someone isn’t having a horrible reaction to something; it’s just something we want to – we can slowly dial back, I find that people tolerate that much better. And are often able to come off of these medicines in the long term.
Host: What important information we’re giving out here on this episode today Dr. Brandt. Wrap it up for us what you would like patients and their caregivers and their loved ones to know about medications that can affect memory, those discussions to have with your physician as you said you must be trusted because some of them have been on these medications for a very long time and what you want them to know about considering those risks and benefits based on what they need the medication for.
Dr. Brandt: I think the take home point would be to always scrutinize the medications anytime a patient is having a new symptom. So today we’re speaking about memory but it could be another symptom even, something maybe even totally noncognitive anytime a patient presents with a new symptom, we should always question could a medication be at least part of the cause for this symptom. Because if we don’t, what we might end up doing is giving another medicine to treat that symptom which might give another side effect and then we end up on another medicine to treat that side effect. We call this the prescribing cascade. So, I think we always have to check ourselves even us physicians sometimes we might forget to do this. Just stop, pause, before we add something see if there is something that we could subtract. And another mantra in geriatrics that I fail to work in but I think it’s important to recognize is anytime a patient is using a medication, whether it’s for memory or for another reason, we always want to start low and go slow. So, we want to – in older adults we might not – they might not tolerate a full strength of something so we often will start with a half of a tablet or just a very lowest strength and gradually increase the dose if tolerated, monitoring very closely for side effects such as memory problems or other intolerance.
Host: It’s great, great information and so important. Thank you, Dr. Brandt, for joining us today and telling us about this really important topic. That concludes this episode of ChristianaCare’s Swank Memory Care podcast series. To learn more about programs and services or to schedule an evaluation at the Swank Memory Center, Delaware’s first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia and other neurocognitive disorders you can call 302-320-2620 or you can visit www.christianacare.org/swankmemorycare for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other ChristianaCare podcasts. Please share this show on social media with your friends and family. We can all learn about medications that have some of those risks that could affect the memory of our loved ones. It’s really important information and we’re learning from the experts at ChristianaCare. This is Melanie Cole.
Melanie Cole (Host): Welcome to ChristianaCare’s Swank Memory Care Podcast series. I’m Melanie Cole and today, we’re talking about medicines that affect your memory. Our speakers in this podcast series represent the Swank Center for Memory Care and Geriatrics, Delaware’s first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia or other neurocognitive disorders. Joining me is Dr. Lynsey Brandt. She’s an Associate Medical Director at the Swank Center for Memory Care and Geriatric Consultation at ChristianaCare. Dr. Brandt, thank you so much for being with us today. First before we get into the medications that can affect our memory, tell us a little bit about your unique background.
Lynsey Brandt, MD, PharmD (Guest): Well thank you for having me and thank you for asking. So, my background is a bit unique as you said. I was originally trained as a pharmacist before I decided to go to medical school. And I recall working in the pharmacy and feeling a little bit removed from my patients and wanted to be a little more directly involved in their care and in their lives and so I took that background and applied that in my medical training and have carried that through into my profession here in geriatric medicine.
Host: That’s so interesting and it’s such an interesting profession that you’re in. So, when a patient experiences significant memory loss, it’s important they seek a medical evaluation obviously to evaluate for potentially modifiable lifestyle or medicational causes of their changes in memory. Tell us how medications can cause changes in memory or clarity of thought.
Dr. Brandt: Absolutely. So, when people come to see me, and they are experiencing a change in their memory, I am charged with looking for underlying causes that we could potentially modify and to help them do better. So, as you stated, medications are one of the major categories that we focus on during tis evaluation. Medications can affect one’s clarity of thought or even their memory directly by the way the medication works in the body. For example, some medications are called anticholinergic medications and these medicines oppose the chemical in our body that help us to remember things. Also, medications can interact with other medicines that someone is taking. So, for instance, you could be using one medicine and it might affect the metabolism of another medicine such that both of them maybe hang around longer in the body or give more affect than either of them would individually.
And finally, patients can also have effects from stopping a medication. So, if it’s something they’re supposed to be taking everyday and they abruptly discontinue it, that might also give them some changes in their memory or their behavior or their clarity of thought.
Host: Well thank you for that explanation Dr. Brandt. So, the aging body handles medications differently which can increase a person’s risk of experiencing these side effects such as memory loss. Do we have any risk factors for this? Do we know about an individual’s risk of a medication causing memory issues?
Dr. Brandt: Yes so, as you alluded to, the changes in our body happen almost universally, naturally as we age. For instance, our kidney function is something that declines with age. And as you may know, certain medications are cleared from the body through the kidneys. So, for example, a patient could be taking a medication called, I’ll use an example specific, gabapentin is one example of something that can be taken for a number of reasons. Often, it’s used for nerve pain or neuropathy. This medication is cleared out from the body through the kidneys. And so, as our kidney function slows down, the level of gabapentin in the body could build up and hang around longer and result in side effects such as confusion, drowsiness, dizziness, or even forgetfulness.
Other things that happen as we get older are changes in our body composition. We have less water and more fat in our systems and some of the medications that distribute into the fatty tissues also might hang around longer. For example, a medicine like Valium if you have ever heard of that, could once a person takes a dose of Valium, could be in their system for many, many days and really have a lasting effect on their memory.
Host: Well thank you again for that. So, let’s talk about besides the ones that you’ve mentioned, gabapentin and Valium, categories of medications. Are there some that are more likely to cause problems when we’re talking maybe sleep meds, because there’s a lot of those and anxiety or antidepressants, stomachaches. There’s so many medications out there that can cause issues. Tell us about some of them.
Dr. Brandt: Now the first thing I will say, I always give a disclaimer when I’m presenting this information for folks. If at some point, I name a medication and it’s something that someone listening here is taking, I don’t want to insight panic. Because in any given patient, the medicine might be the right thing for that particular patient. So, just because it might be on my list of concerning medicines here, perhaps that is the right choice for someone. And I also want to also encourage people that if again, you hear of a medicine here, that I mention is a concern, I wouldn’t want you to stop that abruptly. I’d encourage the patient to discuss it with their medical provider and decide whether it’s something that they want to maybe taper off of or wean off gradually.
With that being said as you said, one of the ones we look at almost universally would be sleeping medications. So, both over-the-counter or prescription. People commonly use something called diphenhydramine. That’s in a lot of sleep aids. It’s sometimes combined also with other pain medicines. So, like acetaminophen and diphenhydramine or naproxen and diphenhydramine. Those are pain medicines with the sleeping medicine can absolutely cause people to be more forgetful and not only that, more off balance and at risk of falling.
Other medicines would be anxiety or nerve pills. Earlier I mentioned the word Valium, the generic name is actually diazepam. So, nerve pills like diazepam, lorazepam can cause people to be forgetful, disoriented, maybe even hallucinate. In addition to just being really drowsy and maybe even a little depressed.
Other medicines we would worry about would be pain medications, usually the narcotics so something like morphine, or oxycodone or even codeine. And then other ones that people might not suspect as much so commonly I see people on medicines for stomach pain or irritable bowel. An example would be something called dicyclomine there’s a common name of Bentyl for that medicine. Notice I’m giving you mostly generic names because we try to speak in the generic drug names. Also medicine for bladder control. Something called oxybutynin is a common one or tolterodine. These medicines while they are good in that they help with the bladder control problem, or the one that I mentioned earlier, the stomach issues; they also tend to cause forgetfulness. They are all in that category of what I called anticholinergic medications, and which can really impact the memory and clarity of thought.
Host: Such a good explanation of the different classes of medications Dr. Brandt. So, how can a patient and you mentioned not to freak out about it, but how can a patient and provider consider those risks and the benefits and what should they discuss and as you said, not to panic about it, if someone does learn that they are taking a medication which can affect their memory, it’s important that they don’t stop abruptly but tell us about the discussion between a physician and the patient on these medications that might affect their memory.
Dr. Brandt: Absolutely. So, I spend a lot of time in my practice exploring what the underlying cause is for the reason a patient might be using one of these medicines. Let’s take sleep as an example. So, sleeping pills are commonly used by many people. We spend a lot of time looking at what is the difficulty with the sleep? For instance, is someone drinking a lot caffeine? Is there a way we can modify that behavior? Or is someone say napping a lot during the day in which case they’re going to be more awake at night. Are there behaviors and other nonpharmacologic things that we can modify in their life that might make the need for a sleeping medication less? So, that’s the first and foremost.
Another example would be anxiety. Again, there are a lot of other medication options or nonpharmacologic things we could do for anxiety. Counseling, meditation, exercise, those sort of things. and then once we – it takes a lot of partnering I would say with the patient and the provider. These patients have to trust us because oftentimes they’ve been on these medicines for years and we have to say look, this is another way that we could approach this. Do you trust me? Do you want to move forward and partner together? Knowing that this is I think a two way conversation and I want the patients to feel like they have some ownership so that they can give me feedback on maybe gradually reducing the medication and implementing some of those other lifestyle type changes.
I often use the analogy also in geriatrics of it’s more of a dimmer switch rather than an on off switch. So, I do a lot of kind of dialing back slowly and I think whenever we gradually make these changes, presuming someone isn’t having a horrible reaction to something; it’s just something we want to – we can slowly dial back, I find that people tolerate that much better. And are often able to come off of these medicines in the long term.
Host: What important information we’re giving out here on this episode today Dr. Brandt. Wrap it up for us what you would like patients and their caregivers and their loved ones to know about medications that can affect memory, those discussions to have with your physician as you said you must be trusted because some of them have been on these medications for a very long time and what you want them to know about considering those risks and benefits based on what they need the medication for.
Dr. Brandt: I think the take home point would be to always scrutinize the medications anytime a patient is having a new symptom. So today we’re speaking about memory but it could be another symptom even, something maybe even totally noncognitive anytime a patient presents with a new symptom, we should always question could a medication be at least part of the cause for this symptom. Because if we don’t, what we might end up doing is giving another medicine to treat that symptom which might give another side effect and then we end up on another medicine to treat that side effect. We call this the prescribing cascade. So, I think we always have to check ourselves even us physicians sometimes we might forget to do this. Just stop, pause, before we add something see if there is something that we could subtract. And another mantra in geriatrics that I fail to work in but I think it’s important to recognize is anytime a patient is using a medication, whether it’s for memory or for another reason, we always want to start low and go slow. So, we want to – in older adults we might not – they might not tolerate a full strength of something so we often will start with a half of a tablet or just a very lowest strength and gradually increase the dose if tolerated, monitoring very closely for side effects such as memory problems or other intolerance.
Host: It’s great, great information and so important. Thank you, Dr. Brandt, for joining us today and telling us about this really important topic. That concludes this episode of ChristianaCare’s Swank Memory Care podcast series. To learn more about programs and services or to schedule an evaluation at the Swank Memory Center, Delaware’s first and most comprehensive outpatient program dedicated to the assessment and assistance of older adults and their caregivers coping with dementia and other neurocognitive disorders you can call 302-320-2620 or you can visit www.christianacare.org/swankmemorycare for more information and to get connected with one of our providers. Please remember to subscribe, rate and review this podcast and all the other ChristianaCare podcasts. Please share this show on social media with your friends and family. We can all learn about medications that have some of those risks that could affect the memory of our loved ones. It’s really important information and we’re learning from the experts at ChristianaCare. This is Melanie Cole.