Is Polypharmacy Risky for People with Dementia?

A new study published in the Journal of the American Medical Association (JAMA) on March 9th reports that 1 in 7 dementia patients take at least 3 medications that act on their central nervous system, despite expert warnings that this type of “CNS-active polypharmacy” can raise the risk of falls, memory issues and death.

“This is one of the most important issues for geriatricians,” said Dr. Howard Fillit, Founding Executive Director and Chief Science Officer of the Alzheimer’s Drug Discovery Foundation (ADDF). “Aging increases the risk for many diseases, and it’s not unusual for older patients, even those without dementia, to be on multiple medications.”

The study examined data from nearly 1.2 million Americans on Medicare and looked at “CNS” medications such as antidepressants, sedatives, opioid pain medicine, antipsychotics, and anti-seizure medications. These types of drugs are prescribed to address common issues in people with dementia, including agitation, psychosis, depression, sleep disorders, and pain. The study only looked at dementia patients who are living at home or in other less regulated environments than nursing homes. The federal government has long targeted the use of these types of medications in nursing homes.

“I would encourage everyone involved in a dementia patient’s care to think about appropriate use of medications to determine if a patient is under or overmedicated, and if there are alternatives to medication. Educating loved ones who are caregivers about non-pharmacological approaches to managing agitation, psychotic symptoms and depression is also important in the attempt to reduce CNS medications,” Dr. Fillit added.

Dr. Fillit noted in a story picked up by U.S. News & World Report that taking too many drugs comes with risks, but the answer lies in individualized care. “Healthcare providers who care for older patients need to build a regular medicine review into their practice to ensure these patients are receiving the smallest number of medicines needed to manage their physical, mental and emotional health.” 

To help minimize some of these risks, Dr. Fillit recommends working with a care team, especially for older patients with multiple conditions.