Can antipsychotic medications worsen memory in the elderly?
Antipsychotic medications, often prescribed to older adults for issues like agitation or hallucinations in dementia, can indeed harm memory due to their anticholinergic effects. These drugs block a brain chemical called acetylcholine, which is key for memory and thinking. In elderly people, this blockage raises the risk of memory loss and confusion, especially with long-term use.[1][2]
Doctors sometimes give powerful antipsychotics to dementia patients, but new studies show they are used longer than guidelines recommend. This extended exposure worsens cognitive problems in fragile brains. For example, research on older adults links cumulative anticholinergic drugs, including some antipsychotics, to poorer cognition over time.[2]
One study looked at nursing home residents with dementia. Those treated with dementia drugs like cholinesterase inhibitors and memantine had better memory outcomes. Interestingly, many could even stop antipsychotics without issues, suggesting these meds were not always needed and might have been slowing brain function.[1] For more details, see https://www.hmpgloballearningnetwork.com/site/altc/articles/use-cholinesterase-inhibitors-plus-memantine-long-term-care-resident-assessment-instrument.
Anticholinergic burden, or ACB, measures how much these drugs affect the body. High ACB from antipsychotics like risperidone or quetiapine hits older adults hard, increasing falls and memory decline. Teams of doctors, pharmacists, and nurses have successfully cut these meds in rural elderly groups, lowering ACB scores.[2] Check this source: https://pmc.ncbi.nlm.nih.gov/articles/PMC12690049/.
Guidelines push for shorter antipsychotic use in dementia care to avoid these risks. Non-drug options, like behavior therapy, are preferred first. Still, in places like memory care units, staff training on risks helps shift away from these meds.[4]
Efforts to reduce antipsychotics in nursing homes have mixed results. Quality measures aim to stop overuse, but some unintended issues arise, like untreated symptoms. Balancing this means careful monitoring.[6]
Sources
https://www.hmpgloballearningnetwork.com/site/altc/articles/use-cholinesterase-inhibitors-plus-memantine-long-term-care-resident-assessment-instrument
https://pmc.ncbi.nlm.nih.gov/articles/PMC12690049/
https://www.aol.com/articles/powerful-antipsychotic-drugs-given-dementia-223907400.html
https://scholarworks.seattleu.edu/cgi/viewcontent.cgi?article=1129&context=dnp-projects
https://www.droracle.ai/articles/681268/what-antipsychotics-anti-psychotic-medications-should-be-used-in-patients
https://www.agingresearch.org/podcast/improving-access-to-patient-centered-care-with-chad-worz-and-dr-amita-patel/
