The risk is all the more worrying as these treatments are often prescribed long-term.
Medication prescriptions – used in particular for incontinence, depression, stress, Parkinson’s disease or allergies – increase with age. However, prolonged exposure to certain treatments is associated with an increased risk of cognitive decline. A geriatrician warns.
The drugs targeted here inhibit the action of acetylcholine, a neurotransmitter that plays an essential role in the transmission of signals between nerve cells, as well as between neurons, and in memory processes. They are called “anticholinergics”. In healthy subjects, prolonged exposure to anticholinergics is associated with brain atrophy, demonstrated by imaging. “In patients already suffering from cognitive disorders – such as those suffering from Alzheimer’s disease, where cholinergic neurons are already largely destroyed, the effect is direct: the quantity of acetylcholine being already reduced, the administration of an anticholinergic worsens the situation. explains Dr Pierre-Edouard Baudouin, geriatrician at Paul-Brousse hospital. According to him, the reduction in acetylcholine could also promote a chronic elevation of cortisol, known to induce persistent inflammation, itself involved in mechanisms of brain degeneration.
Anticholinergic drugs are numerous and are found in several therapeutic classes, including antidepressants, anxiolytics, antipsychotics, antihistamines, urinary antispasmodics or even antiparkinsonians. “While all anticholinergic medications carry a risk, psychotropic drugs — particularly neuroleptics — are among those with the highest anticholinergic burden.informs the geriatrician. Among psychotropic drugs with an anticholinergic effect, the antidepressant Laroxyl (Amitriptyline) is one of the most prescribed. The risk is all the more worrying as these treatments are often prescribed long-term.
Neuroleptics, in particular, are initiated relatively early in life in patients suffering from psychiatric disorders, which prolongs cumulative exposure over the years. “Conversely, other anticholinergic medications, such as those used for urinary disorders (generally from age 60-65) are started later. Those for pain are prescribed for a short period of time so the impregnation is shorter on the patient level.“, deciphers the geriatrician.
Are there therapeutic alternatives to anticholinergics? The answer depends greatly on the indication. “When it comes to psychiatric disorders, including hallucinations or severe behavioral disorders, alternatives to psychotropic medications, particularly antidepressants and antipsychotics, remain very limited. explains the geriatrician. In these cases, the room for maneuver is limited. “On the other hand, for other indications such as urinary disorders or certain cardiovascular pathologies, non-anticholinergic therapeutic options exist and can be considered.“, he emphasizes. It is therefore essential to evaluate the benefit-risk balance on a case-by-case basis, taking into account both the pathology being treated and the patient’s overall anticholinergic load.
