Ask most health professionals what you can do to prevent or delay dementia, and you will likely be told to maintain a healthy diet, exercise regularly, control your blood pressure, blood sugar and body weight and interact with friends and family. Those are all good suggestions, but one key element is often ignored.

People who want to dodge cognitive decline should avoid medications that can interfere with brain function. A systematic review of the medical literature was published in the journal Translational Research & Clinical Interventions (Jan. 21, 2025). The authors reviewed 14 studies containing medical records for 130 million people. There were 1 million cases of dementia in this database.

What the authors discovered is disconcerting. There were some fairly predictable associations, such as drugs for neurodegenerative diseases or symptoms of dementia. Others were unexpected.

A possible connection between digestive distress and dementia is unclear, for example, but several medicines used to treat acid reflux, constipation or nausea were associated with a later chance of a dementia diagnosis. Pain relievers, anticonvulsants, drugs used to treat anxiety or insomnia and those for urinary problems were also linked to an elevated risk for cognitive difficulties.

Many people take anticonvulsant drugs such as gabapentin to treat a variety of disorders. They include nerve pain, back pain, postsurgical pain, pain after a shingles attack, sciatica, migraines, insomnia, bipolar disorder and so much more. There is a concern that gabapentin and a related drug, pregabalin, might pose an increased risk of dementia (Frontiers in Pharmacology, May 30, 2023).

One category of medications that stood out in the analysis is anticholinergic bladder drugs. These medications are frequently prescribed for “overactive bladder.” They don’t simply affect the urinary tract, though.

Anticholinergic drugs interfere with the neurochemical acetylcholine (ACh) that plays a key role in memory. It is not surprising, therefore, that such medications might be associated with cognitive dysfunction (Drugs & Aging, April 2020).

Bladder drugs are not the only pharmaceuticals that impact neurons that rely on ACh. Antihistamines such as diphenhydramine (DPH) are notorious in this respect. Millions of people take DPH every night because this ingredient is now found in so many nighttime “PM” pain relievers.

There are dozens of other drugs with significant anticholinergic activity. Older antidepressants such as amitriptyline are sometimes prescribed to help people sleep because they are sedating. But this drug is considered potentially inappropriate for older people. So is paroxetine (American Journal of Geriatric Psychiatry, August 2019). You can find a comprehensive list of anticholinergic drugs at www.PeoplesPharmacy.com. Just search “list of anticholinergic drugs.”

Antianxiety agents and sleeping pills may also pose a risk for older people. Benzodiazepines such as alprazolam, diazepam, flurazepam or lorazepam have been prescribed for decades to help people overcome insomnia. Prolonged use of such medications is associated with cognitive decline (International Psychogeriatrics, December 2024).

Stopping any medications can be challenging. That’s especially true for benzodiazepines. People taking drugs that might increase the risk of dementia need to ask the prescriber for assistance. If the medication can be discontinued, it may need very gradual tapering to prevent unpleasant withdrawal symptoms.

In their column, Joe and Teresa Graedon answer letters from readers. Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: www.PeoplesPharmacy.com.