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Medication Fog Can Mimic or Worsen Dementia in the Elderly

By the Associated Press

March 3, 2020

Claire Dinneen’s daughters thought that worsening dementia was causing her growing confusion, but her doctor suspected something else.

Dr. Pei Chen asked them to round up medicines in the 89-year-old woman’s home and they returned with a huge haul. There were 28 drugs ordered by various doctors for various ailments, plus over-the-counter medicines. Chen spent a year sorting out which ones were truly needed and trimmed a dozen. 

To her daughters’ surprise, Dinneen got better, able to remember more things and to offer advice on what to wear and how to raise their kids. Her symptoms were from “medication fog,” not her dementia getting worse, Chen told one daughter.

“I was just stunned,” Debbie Dinneen said. “No one had taken a look at the big picture” to see if medicines might be addling her mom, who lives near Berkeley, California.

“Unfortunately, it’s not unusual,” said Chen, a geriatrician at the University of California, San Francisco. 

About 91% of people over 65 take at least one prescription medicine and 41% use five or more — what doctors call polypharmacy. 

The risk of side effects or interactions rises with the number of pills, and one doctor often is unaware of what others have already prescribed for the same patient. Dinneen, for example, had two prescriptions for the same drug at different doses from different pharmacies.

“It’s very easy to miss medication side effects because they masquerade as all these other symptoms,” said Dr. Michael Steinman, another UCSF geriatrician.

He recently helped update an American Geriatrics Society list of potentially inappropriate medicines for older adults that can mimic dementia or make symptoms worse.

“Potentially” is the key word — the drugs on the list don’t always pose a problem, and no one should stop using any medicine without first checking with a doctor because that could do serious harm, Steinman stressed. 

But some medicines don’t have a strong reason to be used and their risks may outweigh their benefits for older people, he and other doctors say. They often “de-prescribe” medicines that may no longer be needed or that once may have been OK but now may be causing problems.

The list includes certain types of muscle relaxants, antihistamines, allergy medicines, stomach acid remedies, antidepressants, anti-anxiety medicines, pain relievers, sleep aids and other common treatments. 

Many of these drugs have anticholinergic effects — that is, they reduce or interfere with a chemical messenger that’s key to healthy nerve function. That can cause drowsiness, confusion, blurred vision, dizziness and other symptoms that impair thinking skills. 

These drugs might be fine for a younger person, but “once someone is having even the tiniest difficulty with thinking and memory, then the effects of these drugs are just huge,” said Dr. Andrew Budson of Boston University’s Alzheimer’s disease center. 

Sometimes side effects appear right away but in other cases they only develop or show up with longer use. Patients may not make the connection between a drug they’ve used for many months and new symptoms. Age itself can be a culprit and make a long-used drug suddenly intolerable.

“The drug hasn’t changed, the person has,” said Dr. Greg Jicha, a dementia specialist at the University of Kentucky.

Family members will say, “‘well, she was on that for 20 years,’ but her brain, kidney, liver were younger too. She’s no longer going to be able to metabolize that drug” like she used to, he said.

Jicha recalled a case last year when he was asked to give a second opinion on a woman recently diagnosed with Alzheimer’s disease. He reviewed her medicines and “six jumped right out — these are not good medications for someone over 65” let alone at the higher doses she was receiving, he said. Four turned out to be for problems she no longer had, and he was able to switch some others to safer alternatives.

The woman’s score on a 38-point test of thinking skills rose from 18 before the medication changes to 33 after them, putting her at the low end of the normal range. 

Now she can drive, which was “an absolute no-no six months earlier,” Jicha said. “She clearly no longer meets criteria for dementia.”

One of his colleagues, Dr. Daniela Moga, heads a study to see whether optimizing medicines can delay the start of dementia symptoms. At the Alzheimer’s Association International Conference in Los Angeles in July, she described the federally funded research, which involves people who are 65 or older and taking at least one medicine on the geriatrics society list. 

All have normal thinking skills although some showed signs on brain scans of possible dementia developing. Participants are given a sort of cognitive stress test — they take exams for thinking skills while wearing a patch that oozes scopolamine, a motion sickness drug that has anticholinergic effects, and then four weeks later without the patch. If they do worse while on the patch, it means certain medicines might be harmful for them, Moga explained. 

“We want to see if we can identify a specific group that might benefit most” by carefully managing medication use and possibly delay the start of dementia symptoms, she said.

To help avoid medication problems, doctors give these tips:

—Make sure you know all the medications someone is taking, including prescription, over-the-counter and vitamins or dietary supplements. Don’t assume that some are safe just because they don’t require a prescription.

—Keep a running list with the date each medicine is started and stopped and note any symptoms. The National Institute on Aging offers a worksheet for this.

—Review the total medication list with a doctor, a geriatrics specialist or a pharmacist. 

—If you suspect a problem, bring it up and don’t wait for your doctor to ask. The American Geriatric Society’s Health in Aging Foundation has these tools and tips for finding alternatives to any medicines causing trouble. 

Thinking About Volunteering?

Winter is a great time to escape Wisconsin snow and cold for some of our volunteers. But that means Among Friends is a little shorthanded during the winter months. If you are looking for an opportunity to do some good while having fun, we might be the right fit for you.

“What can I do?” you might be asking.

You know those travel slides, photos, and books you have tucked away? How about bringing them to Among Friends and sharing them? Our participants love to hear about and see images of places near and far.
Are you a cribbage player? We can use you!

We can always use people to welcome participants and their caregivers as they arrive, to help with lunch, or simply to chat with our participants during activities. If you would like to volunteer, contact Norma at 715-293-2561.

A Very Merry Christmas

Christmas came a little early to Among Friends on December 17th. For a third year, we invited the community to join us to share the best songs of the season, good cheer, and cookies!

The Gugala family, who regularly visit Among Friends, not only sang together but also shared their other musical skills on the piano and violin. Martha TerMaat, Among Friend’s musical director, along with volunteer Ruth McNamara, led everyone in our favorite Christmas carols. One of our other regular volunteers, Bob Emberger, read some poems for the group, including Robert Frost’s “Stopping by the Woods on a Snowy Evening.” Volunteer Lou Grube played a couple of our favorite carols on the concertina.

Among Friends volunteers, participants, and families had a great time sharing the spirit of the holidays. We also had lots of great homemade cookies and drinks. But best of all were the conversations we all had, remembering special Christmases and anticipating ones to come.

All of the staff and volunteers at Among Friends wish everyone a wonderful Christmas and a very happy New Year.

Among Friends will not be open on December 24th, but we have lots of fun activities planned for New Year’s Eve day on December 31st to bring in a joyous 2020!

Cookies and Carols

On Tuesday, December 17th at 1:30, Among Friends is hosting our third annual community holiday song program. The afternoon will include music and readings from our volunteers, an opportunity to sing some of your favorite holiday music, and some sweet treats.

Please join us in the fellowship hall at First Congregational UCC, 110 North Third Street in River Falls. Everyone in the community is welcome!

Dogs–and Fun!

Who doesn’t like a lick on the face, a snuggle, or a loving look from big brown eyes? Participants at Among Friends on a dreary November day experienced a little sunshine with the UW-River Falls students and their dogs in the ADEPT program (Assistance Dog Education Program and Training).

The mission of Among Friends is to provide many different kinds of socialization opportunities. Quality time with furry buddies, music, art, chair yoga, and other activities are all part of our day.

If you know someone with memory loss, let their caregiver know about who we are and what services we can offer. Give us a call (715) 293-2561 or send us an email at amongfriendsrf@gmail.com.

Caring for Caregivers

Next month four former U.S. Surgeon Generals will appear at the International Council on Active Aging in Orlando, Florida, to demand a national infrastructure to help family caregivers. Paula Spencer Scott reports in a recent Parade magazine article that they hope to draw attention to the burden of responsibility that family members now face–often without help–in taking care of their loved ones with memory loss.

Taking care of a spouse, parent, or sibling with dementia can be overwhelming, exhausting, and isolating. But there is help.

Technology

  • Clocks that are easy to read and provide year, month, date, and time are one helpful device. These clocks may help to alleviate some people’s anxiety since those in early stages of dementia often lose their sense of time. (See this article for a more details: https://www.alzheimers.net/9-10-14-clocks-for-dementia/).
  • Appliance use monitors can really provide caregivers with peace of mind. If your loved one is still able to home alone for periods of time, you can still be assured that he or she is safe by using devices such as Evermind monitors that track your loved one’s use of their electrical appliances. “A small, white Evermind box plugs into a wall outlet or power strip, with the appliance plugged into the box. Using built-in wireless Internet, Evermind alerts you if the appliances your loved one normally uses each day have not been turned on or off. Compatible appliances include microwave ovens, coffee makers, TVs, lamps, curling irons, CPAP machines, garage door openers and more. No home Internet connection is required” (Caregivers.com).
  • Tracking devices can be used to make sure your loved one is not wandering or leaving the house or yard. Alzheimers.net has a list of some of the most popular and useful of these GPS tracking devices.
  • Motion sensors can also be helpful. Pads for beds and monitors can alert caregivers if their loved one gets out of bed in the night.

Community

Caregivers are not alone on their caregiving journey. Others are available and willing to help.

  • If you are comfortable on Facebook, you can find at least 11 groups of caregivers who can provide you with a sense of community. You will find others who are going through what you are experiencing, or perhaps you can share your experiences with others who need your help.
  • Veterans and families of veterans have a couple of caregiver groups to help. The Elizabeth Dole Foundation has created a website and caregiver network (also on Facebook) for veterans who are caregivers or for caregivers of veterans. See the Hidden Heroes website for more information and to connect with others.
  • A local caregivers support group meets every Friday at 9:30 a.m. at St. Bridget’s Catholic Church in River Falls.

Celebrate July 4th with us–on the 2nd!

We are ready to celebrate America’s birthday on Tuesday, July 2nd at 1:30 at the First Congregational Church in River Falls. How about joining us in singing good old patriotic songs, sharing ice cream, and having fun? Everyone of all ages is invited. Bring your friends, your grandchildren, your neighbors. It will be a great way to kick off the holidays.

See you on Tuesday at 1:30!

Spring and Summer

It has been a busy time for us at Among Friends. But it is the good kind of busy–busy with activities, with social interactions, with music and art, with children, and with enjoying every moment.

At Easter, the children of a local family who regularly visits Among Friends and our participants colored Easter eggs. It was fun for everybody.

In May, we celebrated the Kentucky Derby with our own River Falls version of Derby Day. In anticipation, we decorated hats. What would the Derby be without extravagant hats? But in our race, everyone was a winner.

Summer means that it is time for growing things. So, with the help of a grant from Allina, we are growing an herb garden. We have planted the seeds, are watching them grow, and are beginning to harvest some of them to create nutritional snacks and meals.

Our caterer, Kathy Kapaun, demonstrated using fresh herbs in four different recipes for our lunch last week. She did a great job in making it a visual, oral and olfactory experience!

We are finding time also to take some walks around the neighborhood and to enjoy the summer sunshine. All in all, it has been a great spring and summer–and we have lots of good activities yet to come in the weeks to follow.