Mixed meds

We all want to live long, healthy lives, but most of us accept that those two adjectives generally don’t go hand in hand. The longer we live, the more likely we are to develop one sickness or another. Or several simultaneously. Which means lots of physic.

But what if those incontinence pills react badly with the dementia therapy? A team of doctors headed by Kaycee Sink at the Wake Forest University in North Carolina sifted through data from over 3,500 nursing home patients to find the answer to this question. Their study appeared in the May edition of the Journal of the American Geriatrics Society.

Dementia patients are often prescribed cholinesterase inhibitors to slow down the decline in cognitive function and their ability to perform daily tasks. These drugs work by increasing the amount of a substance called acetylcholine, which is underproduced in the brains of dementia patients.

Patients with dementia often also suffer from urinary incontinence, and the drugs typically given for this condition do the opposite of what cholinesterase inhibitors do: incontinence drugs are anticholinergics, which reduce the amount of acetylcholine. So in theory, the drugs for incontinence should counteract the dementia treatment.

Prescribing these two opposing medications is common practice, even though nobody really knows how the two drugs interact: Dr. Sink and her colleagues found that at least one in ten nursing home residents receive both cholinesterase inhibitors and anticholinergics.

The researchers examined the medical data from patients who had been taking either the two drugs together, or just the cholinesterase inhibitors alone, for at least two years. For both groups, they looked at the patients’ ability to perform normal activities of daily living.

Both groups showed a decline in mobility, as expected for dementia patients. Perhaps not surprisingly, the decline in mobility was 50% faster in patients taking both drugs together than in those that didn’t take the anticholinergics. This translates to a change from requiring limited assistance for daily activities to being completely dependent on care givers within one year.

This poses a difficult dilemma for nursing home doctors: treat the dementia symptoms or the incontinence? And surely these aren’t the only two ailments with conflicting treatments.