Medication groups that deserve particular attention
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Strong anticholinergic drugs — Examples include diphenhydramine, some bladder medicines such as oxybutynin, and certain tricyclic antidepressants. Long-term cumulative exposure to strong anticholinergics has been associated with increased dementia risk, although an association does not prove that the medicine directly causes dementia.
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Benzodiazepines — Drugs such as diazepam, lorazepam, alprazolam, and clonazepam can cause sedation and short-term cognitive impairment. Observational studies have also raised concerns about cognitive decline with use in older adults.
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“Z-drugs” for insomnia — Zolpidem and similar medications can cause drowsiness, impaired cognition, dizziness, and falls, with older adults being particularly susceptible.
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Certain opioids and other sedating medicines — These can cause confusion and impaired alertness, especially when combined with other central-nervous-system depressants.
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Some older antihistamines — First-generation antihistamines such as diphenhydramine have anticholinergic effects and can cause confusion and other cognitive problems in older adults.
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Some antipsychotic medicines — These can cause significant sedation and other adverse effects in older adults. In people with dementia, antipsychotics carry a boxed warning concerning increased mortality and therefore require careful medical supervision.
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Certain anticonvulsant/neurological medicines — Some can produce sedation or cognitive side effects, particularly at higher doses or when several medications are combined.
