Medications that deserve particular caution
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Oxybutynin — an anticholinergic used for overactive bladder. Long-term cumulative use has been associated with increased dementia risk in older adults.
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Tolterodine — another anticholinergic bladder medication associated with dementia risk in observational studies.
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Solifenacin — also associated with increased dementia risk with greater cumulative exposure.
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Diphenhydramine — an OTC antihistamine with strong anticholinergic effects; anticholinergic exposure in older adults has been associated with cognitive decline and dementia.
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Doxylamine — another strongly anticholinergic OTC sleep aid; prolonged anticholinergic exposure is a concern in older adults.
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Benzodiazepines such as alprazolam, lorazepam, and diazepam — can cause memory impairment and cognitive effects, particularly with prolonged use. Some observational studies have reported an association with dementia, although causality remains debated.
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Other drugs with substantial anticholinergic burden — this is a broader category rather than one specific drug. Multiple medications with anticholinergic properties taken together can substantially increase cognitive and delirium-related problems in older adults.
