Acetylcholine is a neurotransmitter compound (brain chemical that allows nerve cells to speak with one another) associated with memory function. The link between acetylcholine levels in the brain and memory function is so tight that a group of medications mimicking the effect of acetylcholine are used as drugs for memory disorders, dementia and Alzheimer disease (AD). Hence, the findings of CDR Jack Tsao, USN, associate professor for the Uniformed Services University of the Health Sciences' (USU) Department of Neurology linking the use of anti-cholinergic (meaning drugs that block the action of acetylcholine and related compounds) drugs such as medications used in the treatment for stomach cramps, ulcers, motion sickness, overactive bladder and other conditions, to a more rapid decline in cognitive ability in older people comes as no surprise.

His study investigated the effects of consumption of medications with anti-cholinergic actions on the mental status of 870 Catholic nuns and clergy members who were about 75 years old.They underwent annual cognitive testing. In the study, 679 people took at least one medication with anti-cholinergic activity. The results revealed an association between the use of these medications and a decline in cognitive function that was 1.5 times as rapid as those who did not take the drugs.

"Our findings point to anti-cholinergic drugs having an adverse impact on cognitive performance in otherwise normal, older people," said Jack Tsao, M. D. "Doctors may need to take this into account before prescribing these commonly used drugs." Tsao noted that more research is required to define the exact mechanisms responsible for the rapid memory loss apparently associated with anti-cholinergic drugs and to identify which drugs were the primary offenders.

The study concept arose when one of the lead authors, Kenneth Heilman, M. D.,was evaluating a patient with memory complaints and hallucinations. Her cognitive testing was essentially normal with the exception of some memory issues. She didn't fit the criteria for Alzheimer-type dementia. However, she had just begun therapy with tolterodine (Detrol) a drug used to treat over-active bladder and urinary incontinence. After stopping the medication, her memory problems improved. When they reviewed the medical literature, they found that many medications that are not advertised as anti-cholinergic actually have anti-cholinergic properties when tested.

Anti-cholinergic medications range from the overactive-bladder drugs to anti-Parkinsonian agents, anti-spasmodic drugs for the bowel, ulcer medicines, antihistamines and other drugs with less well-known anti-cholinergic activity including lasix, coumadin and ranitidine (Zantac). Examples of some of these drugs are as follows:

Clidinium (Quarzan)

Dicyclomine (Bentyl)

Oxybutynin (Ditropan)

Amitriptyline (Elavil)

Imipramine (Tofranil)

Carbamazeine (Tegretol)

Cyclobenzaprine (Flexeril)

Orphenadrine (Norflex)

Trihexyphenidyl (Artane)

Benztropine (Cogentin)

Chlorpheniramine (Chlortrimeton)

Brompheniramine (Dimetane)

Cyproheptadine (Periactin)

Diphenhydramine (Benadryl)

Chlorpromazine (Thorazine)

Olanzapine (Zyprexa)

Transderm Scop (Scopolamine)

Solifenacin (Vesicare)

Check with your health care provider to see if there are alternatives to these drugs if any of these names are medications you are taking.