Colleagues
While I applaud last week’s publication of the Lancet Commission report on Dementia 2024 that provided updated information on #dementia risk factors and prevention, I am disappointed that drug-induced dementia has not been included. It seems the Commission approached the term exclusively as a primary brain disease rather than also as an avoidable or potentially reversible impairment of cognition.
Drugs that predispose to confusion and #cognitive impairments as side effects are ubiquitous in healthcare, most notably those that interfere with the brain’s #cholinergic receptors, the most common in the organ. People with impaired blood-brain barrier competence due to e.g. age-associated degeneration or neuropathic diseases, most notably the #elderly and people with multiple sclerosis (#MS), respectively, appear especially susceptible to cognitive impairments induced by drugs with anticholinergic effects that enter their circulatory system and travel around their bodies, so get delivered into to their brain parenchyma .
The elderly and in people with #MS commonly are treated with oral anticholinergic drugs for e.g. #urinaryurgency (as overactive bladder syndrome and neurogenic urgency) and depression. Heaven only knows how many such people consequently, have been and will be transferred into institutional care having been diagnosed with dementia that actually was due to urinary urgency and/or depression treatment. Such drug use should be considered in dementia workups.
With that in mind, given the remit of the Commission to look into factors for dementia, I wish to suggest it should include iatrogenic cognitive impairments. Treatment of urinary urgency would be a good place to start. We need to do all we can to reduce the growing burden of dementia, so should consider its iatrogenic causes and raise awareness with prescribers, patients and their significant others because anyone who is aware could pick up on the clues.
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