Wednesday, June 1, 2016

Brain Shrinkage in Older Adults Proven with the Use of Anticholinergic Drugs such as Ranitidine- JAMA

Indiana University School of Medicine published a study in JAMA Neurology  which showed brain shrinkage and larger ventricles on MRI's of the brains of persons taking commonly used drugs called anticholinergics and cognitive impairment more so than those who took no anticholinergic medications. These anticholinergics can be found in over the counter medications to treat colds and flu, heartburn and in prescriptions.

Researchers write:The use of anticholinergic (AC) medication is linked to cognitive impairment and an increased risk of
dementia. To our knowledge, this is the first study to investigate the association between AC medication use and neuroimaging biomarkers of brain metabolism and atrophy as a proxy for understanding the underlying biology of the clinical effects of AC medications.

They studied 480 older adults mean age of 73 who had no cognitive impairment and followed them for an average of 32 months.

To reach their conclusions, the researchers used PETs, a type of scan, to measure brain metabolism, MRI's to scan brain structure, and a series of cognitive and memory tests.

The Researchers  conclude:

The use of AC medication was associated with increased brain atrophy and dysfunction and clinical decline. Thus, use of AC medication among older adults should likely be discouraged if alternative therapies are available.

From ScienceDaily:

Drugs with anticholinergic effects are sold over the counter and by prescription as sleep aids and for many chronic diseases including hypertension, cardiovascular disease, and chronic obstructive pulmonary disease.

A list of anticholinergic drugs and their potential impact [called an ACB score]is at

Scientists have linked anticholinergic drugs cognitive problems among older adults for at least 10 years. A 2013 study by scientists at the IU Center for Aging Research and the Regenstrief Institute found that drugs with a strong anticholinergic effect cause cognitive problems when taken continuously for as few as 60 days. Drugs with a weaker effect could cause impairment within 90 days.

The current research project involved 451 participants, 60 of whom were taking at least one medication with medium or high anticholinergic activity. The participants were drawn from a national Alzheimer's research project -- the Alzheimer's Disease Neuroimaging Initiative -- and the Indiana Memory and Aging Study.

As noted at Aging Brain (my bold)

- each definite anticholinergic may increase the risk of cognitive impairment by 46% over 6 years. (1)

- for each on point increase in the ACB total score [see the link which explains how to do this addition], a decline in MMSE (memory test) score of 0.33 points 
 [out of a total of 30] over 2 years has been suggested. This means if you take 3 drugs with an ACB score of 1 and one drug with an ACB score of 3, your total ACB score is 6 and your risk over 2 years time is the loss of 2 points off the MMSE (memory) test, which is a very large drop in cognitive function. (2)

- additionally, each one point increase in the ACB total score has been correlated with a 26% increase in the risk of death.  Anticholinergics not only affect your brain but your whole body. 4 

In conclusion: Older adults might want to avoid using a class of drugs commonly used in over-the-counter products such as nighttime cold medicines, heartburn medicines or allergy medicines due to their links to cognitive impairment. 

And you may want to talk to your doctor if you are over 65 and you are on one or more of the anticholinergic prescription drugs listed in the list at this link.


1. Campbell N, Boustani M, Lane K, et al. Use of anticholinergics and the risk of cognitive impairment in an AfricanAmerican population. Neurology. 2010;75:152-159. 

2. Fox C, Richardson K, Maidment I, et al. Anticholinergic medication use and cognitive impairment in the older population: the Medical Research Council Cognitive Function and Ageing Study. Journal of the American Geriatric Society. 2011; 59(8): 1477-1483.

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