Know this Word: Anticholinergic

From Mary: An earlier post, My Dad and the Sea (REFLECTIONS, March 2012) was about my father’s injuries and hospital stay. Now I’ll shift gears and wade carefully into the sea of pharmaceuticals. Forgive the wordiness. Most medical terms are literally Greek.  

If you are elderly or advocating for someone who is, you should know the term  anticholinergic. Anticholinergics are drugs which block the neurotransmitter acetylcholine. As neurotransmitters go, acetylcholine is a big player in the ability to form new memories. Several of the main treatments now available for Alzheimer's disease prevent the breakdown of acetylcholine, so it’s not a great leap of logic to assume that drugs which inhibit acetylcholine are potentially bad for the brain. Worse, yes, if taken long term, as antihistamines often are, but the fact is that no one really knows how much is too much, and it may be related to individual factors. The elderly, we can all agree, are more sensitive and vulnerable to the effects of medications and require careful medical management. Researchers publishing in the Journal of the American Geriatrics Society asserted much the same. Here is the flatly stated conclusion in the article’s abstract: “The use of medications with anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.” None of that equivocating rhetoric we sometimes get from scientists squirming away from absolutes.

These drugs should be used with caution in the elderly. Period.  

I wish I had been better informed, when standing over my father, demanding that a geriatric neurologist oversee the plethora of medications he was being given. The hospitalist assigned to his case was dismissive. “Der is no such ting as a jellyatlick neurologist,” he chuckled, in heavily accented English. “Neurologists treat efreebootie. Dey all treat efreebootie. Young, old, meen, whimeen…”

I stared at him incredulously. I felt like saying “There may not be many in your country. Amazingly, we have them here in America.” But sarcasm, however tempting, would not have helped my father. I have the following suggestions for the adult children of elderly parents prone to serious falls, which invariably result in hospitalization: Make certain your parent has an established personal physician, preferably a geriatrician familiar with the effects of various drugs on memory loss. Write down his or her current medications and keep the information in an easily accessible place. Make it your business to stay fully informed of what is being done to and with your loved one. You may not win a popularity contest at the hospital, but this will be the least of your worries.