Could Your Medicine Cabinet Be Affecting Your Memory?

Some prescription and over-the-counter medications can affect memory and thinking, particularly as we age. That does not mean you should stop taking them. It means your medicine cabinet deserves an occasional professional review.

One medication helps you sleep. Another manages allergies. A third calms an overactive bladder.

They may seem unrelated, but the brain does not organize medications by pharmacy aisle. Several can affect the same chemical system, and those effects can add up.

The medications of concern are called anticholinergic medications.

Before giving everything in your medicine cabinet an eviction notice, here is what you need to know.

What Are Anticholinergic Medications?

Acetylcholine is a chemical messenger involved in memory, attention, learning, digestion, bladder function, muscle movement, and other processes.

Anticholinergic medications block some of its activity. Sometimes that is exactly what the medication is supposed to do. The same action that helps control bladder spasms, nausea, or allergy symptoms, however, may also affect the brain.

Possible side effects include drowsiness, blurred vision, dry mouth, constipation, confusion, and memory problems. Older adults can be especially sensitive because medications may be processed differently with age and because the number of prescriptions tends to grow while the medicine cabinet somehow never gets any larger.

The 2023 American Geriatrics Society Beers Criteria recommends considering a person’s total anticholinergic burden. Cumulative exposure has been associated with increased risks of falls, delirium, and dementia.

This does not mean every medication on the list is wrong for every adult over 65. It means the benefits, risks, dosage, duration, and alternatives deserve review.

Where Might Anticholinergic Effects Be Hiding?

Medications with anticholinergic properties may include some:

• Allergy and cold medications

• Nighttime sleep aids

• Bladder-control medications

• Antidepressants

• Antipsychotic medications

• Medications for nausea, dizziness, or motion sickness

• Muscle relaxants

Common active ingredients with strong anticholinergic effects include diphenhydramine, doxylamine, oxybutynin, amitriptyline, and paroxetine.

Not every medication in these categories has the same effect. Brand names can also be misleading because one brand may sell several products with different ingredients. “PM” products often combine a pain reliever with a sedating antihistamine.

The front of the box is marketing. The Drug Facts label tells you what is actually inside.

You can search active ingredients and estimate your combined medication burden using the ACB Calculator. Because scoring systems differ, use the result to begin a conversation with your pharmacist or healthcare professional, not as an instruction to stop a medication.

What Does the Dementia Research Show?

Several observational studies have associated greater cumulative exposure to strong anticholinergic medications with increased dementia risk.

A large 2019 study published in JAMA Internal Medicine compared 58,769 people diagnosed with dementia with 225,574 matched controls. Higher cumulative exposure was associated with higher odds of dementia.

The strongest associations involved certain antidepressants, bladder medications, antipsychotics, antiepileptic medications, and antiparkinson medications.

The study did not find a statistically significant dementia association for every type of anticholinergic medication. Antihistamines, for example, were not among the medication categories with a significant association.

That distinction matters. An occasional antihistamine is not the same as years of daily exposure to one or more strongly anticholinergic medications.

The research is observational, so it cannot prove that these medications caused dementia. The useful conclusion is that cumulative exposure is a potentially modifiable factor worth reviewing.

What Is Anticholinergic Burden?

Anticholinergic burden is the combined effect of all medications a person takes that have anticholinergic properties.

One strong medication may create a meaningful burden. Several medications with milder effects may also add up.

You might take an allergy medication, a bladder medication, and an occasional sleep aid without realizing that all three are tugging on the same neurological rope.

That is why a medication review should include everything you take:

• Prescription medications

• Over-the-counter products

• Sleep aids and “PM” products

• Occasional remedies

• Supplements and cannabis products

Your clinician may know what appears in your medical record but not what you pick up at the grocery store or order online.

Should You Stop an Anticholinergic Medication?

Not on your own.

Some medications should not be stopped abruptly. Doing so can cause withdrawal symptoms, a return of the condition being treated, or other serious problems.

A medication review is not a raid on the medicine cabinet. It is a chance to determine whether each medication is still needed, whether its benefits outweigh its risks, and whether a lower dose or less anticholinergic alternative might be appropriate.

A pharmacist, primary care clinician, geriatrician, neurologist, or prescribing specialist can help.

Bring a complete medication list or, even better, bring the bottles. Ask:

• Do any of these medications have anticholinergic effects?

• What is my total anticholinergic burden?

• Could any be contributing to memory problems, confusion, dizziness, or falls?

• Is there a lower dose or less anticholinergic alternative?

• Would any change require a gradual taper?

If you notice sudden confusion, seek prompt medical attention. New or worsening memory problems, excessive sleepiness, hallucinations, falls, or difficulty managing everyday activities also deserve medical evaluation.

One Simple Action

Gather every prescription, over-the-counter product, sleep aid, and occasional remedy you use.

Take the complete list to your pharmacist or healthcare professional and ask:

“Could any of these medications be affecting my memory or increasing my total anticholinergic burden?”

You may learn that no changes are needed. You may uncover a duplication, an outdated prescription, or an alternative worth discussing.

Either way, a periodic medication review is a practical part of a broader dementia risk-reduction strategy. Every medication should still be earning its place in your medicine cabinet.

References

1. American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 Updated AGS Beers Criteria® for Potentially Inappropriate Medication Use in Older Adults. Journal of the American Geriatrics Society. 2023;71(7):2052–2081.

2. Coupland CAC, Hill T, Dening T, et al. Anticholinergic Drug Exposure and the Risk of Dementia: A Nested Case-Control Study. JAMA Internal Medicine. 2019;179(8):1084–1093.

This article is for educational and informational purposes. It does not replace individualized medical evaluation, diagnosis, medication review, or treatment. Do not begin, stop, or change a medication without consulting a qualified healthcare professional. See the complete Disclaimer.