Medications & Memory with Dr. Elena
00:00:01 – 00:05:01
Welcome to fading memories a podcast with advice wisdom and Hope from caregivers, who have lived the experience and survived to tell the tale. Give us as your caregiver best friend. Today’s podcast is presented by Pago. Pago is the easiest way for you to monetize your podcast. Providing podcasters with a flat rate for ad space so you always know how much you get when you include an ad from pod go apply today to become a member and immediately be connected with advertisers that fit your audience. That’s pod, go off Geo and be sure to add fading memories in the, how did you hear about, pug? Go section of the application. As caregivers to an older person, the chances are they’re taking a number of prescription medications. Have you ever wondered, if they are on the proper medications. Do you worry about how side effects and interactions may be contributing to other health problems. Of course, these are practical concerns to have. Although medications often help maintain health and well-being Studies have repeatedly shown that many older adults often suffer from medication problems in this episode. I am joined once again by doctor Alina she and I discussed common medications prescribed to older adults and how we should evaluate them for Effectiveness versus side effects. Hey there. Before we get into the show, I have a question for you. Do you want a place to ask questions and get honest answers from me and my guests? If you wish to get direct access to the people who share their knowledge on the podcast, then head over to my Facebook page over there. We can grow a supportive Community. We can answer your questions and if you want extend a conversation on the week’s topic, the link is in the show notes. If you’re interested pop over to the page and post, I’m in and we’ll go from there. Thanks. Back with me today, is guest host, dr. Elena mujy. I have learned so much from her Instagram account and I no longer have older. Loved ones, I have to worry about and all of the information I’m learning from her, it’s going to help meet age. Well, so that is part of the reason we’re having these conversations and today we are talking about common medications in older adults. So thanks for joining us again, dr. Moochie thank you very much, thank you for having, you’re welcome. So you said we’re not going to focus on blood pressure medications, diabetes, and dementia medications because those are the most common, and if I understood correctly, if they are not prescribed appropriately, they can actually make dementia worse. That is correct. That is correct, and exactly. And I’m happy to crack on with it. I know the time is limited and shall we get started with diabetic complications? Definitely, I don’t know if I told you that my dad was diabetic and he had a kidney transplant in 2009, but he was one of those people that didn’t do not take care of it. Well, and we all know what the end result was that? How that what happens with that? Yeah, yeah. Well with diabetes, diabetes of course is dead it into type one and type two and type one when you are completely lacking insulin and usually develops in younger patients and from their very beginning you are dependent on insulin injections wage has type two diabetes is when your body is still producing a little bit of insulin but your body cells are not quite responding to your body’s incident. So we prescribe Medications to help the body to respond to your own insulin. However, as the years go by, with some patients, the body stops responding to its own insulin with medications and some type two diabetic. Patients, end up going on insulin injections, and that is done with a purpose of controlling diabetes, very tightly as you’ve just rightly said, your dad ended up with a kidney transplant, why? Because if you don’t control your diabetes properly, you do end up damaging fine. Blood vessels of the body wash, which can lead to kidney, failure and need for transplant to brain disease, Two Strokes, two heart attacks. You name it all the the Peripheral arterial disease, legolas’s. So, diabetes is a can be quite nasty.
00:05:01 – 00:10:03
However, what I observed in my older patients as the years go by and we do birth And job a lot of my patients do end up on insulin but as they grow older the need for insulin goes down and that’s what I would like to discuss because if this is not reviewed the diabetes gets always treated, the blood sugar levels. Go too low and people end up having a cold hypoglycemic attacks and collapse. You see in all the patience, with all the people they’re high posts, do not present the same way. As, with younger ones, younger ones, they feel like they’re sweating and they become very nosey ass and they know when they need to take their sugar. And with all their people, the hypos can present wage memory problems, memory, decline, worsening of their dementia Falls. You see very, very non-specific presentations. So all were treated birth. Beaches in all the population is a becoming a huge problem and especially with dementia patients. We have enough evidence out there showing that over track of diabetes can lead to new memory problems or deterioration of Dementia in patients with already known dementia interesting because my dad seemed fine not well, but his mind seemed fine until November 29th, 2016. We went to spend time with my parents, decorate, the house for the holidays, my husband walked in the door, and my dad said, so how’s the Credit Union business? Treating you and my husband, his heart dropped because he hadn’t been in the Credit Union business in fifteen years and so he knew something was desperately wrong and had I known what was actually going on. I I home. I would have been smart enough to call Hospice. Instead of the trauma route that we went, where he was in the hospital for 32 days, and then he was home on hospice and or well, then he was home, and he fell back in the hospital. And then, he came home on hospice, it was not a lovely time, not at all, not at all, and Jenny why these things happen, why do they all the page told the people get the hypos, how come they are diabetes, which was beautifully controlled years ago, becomes over treated and the key, we are talking, of course, about type two diabetic. Patients, the key to understanding is is to understand the physiology as we age, especially with all the adults, you know, problems with Dentures problems with appetite phone number, what, the medical concerns. They don’t eat that much inevitably as the years go, by a lot of us will be losing weight and as the way it goes down the phone. Tissue goes away and our own body cells. Suddenly open up and respond. Now, to the little insulin, your body, still producing this type two diabetes and the need for insulin actually diminishes. So it is so important especially with patients with dementia with impatience no memory concerns. If they are type 2 diabetics and their own insulin to one discuss with their primary care physician. What are their target? Diabetic levels are down because the targets get increased. You say, as we in all the population, the targets for diabetic diabetic control are not the same as it would be in younger population. So they need to get that bigger have the medicines reviewed and I personally end up in my practice, taking a lot of all the patients off their insulin and adjusting their dog. Tablets. And of course, you will appreciate this makes everyone’s life so much easier, especially with memory problems, injected insulin, causing the pain, people not understanding, why that actually being injected and prickled those needles and hurt manager. The diabetes for their loved ones, becomes easier. So there are a lot of implications but the main one of course, I’d like to emphasize all the treatment of diabetes can lead to worse and in memory problems worsen in dementia, So if we have a loved one with diabetes and they are losing weight than we, that should be a definite clue to have their medications re-evaluation, definitely from all sorts of perspectives all medicines, really, because a lot of medicines are prescribed, as per body weight and I’ll talk about the very simple one-page.
00:10:04 – 00:15:20
Is paracetamol you call it in America under determine or yeah. See the medicine aspirin. Yes, I said. Yes, ma’am. We call it here across the ocean paracetamol. So usually it is prescribed in a dose of one, gram, four times a day. But if your body name is below fifty kilograms, that should the doors should be hot. Otherwise, you will be at risk of actually having the overdose. So that’s a simple example with a drug which is used on date palm. Basis it’s so commonly used isn’t it as a painkiller? But the same true about many other medications including diabetes. But as I said with diabetes the mechanism is a little bit different physiological and disease-related decline which leads to weight loss. As we grow older makes our body cells more responsive to our own insulin, which we still produce as type two diabetics. Of course it is all should be very, very close, the monitored but to our listeners, if you have a loved one with type, I diabetes diabetes whole years ago, ended on insulin to have a better control of their diabetes and now they’re in the eighties nineties with memory problems. Please review page need for that instrument, maybe there is no meat anymore. Which would be nice. I think my dad was a challenge on evaluating his medications because he didn’t, he didn’t eat the way he was supposed to and he didn’t exercise. So that leads me to my next question. When we lose body weight, you said, when you lose fat tissue, our bodies May respond to our own insulin. Not projection, but our kitchen. Yeah, what happens if you lose muscle mass cuz my dad was not thin. He wasn’t losing weight but he definitely was losing muscle because he wasn’t effective cuz he was always in pain. I’m not aware that, that has major difference, really? I mean, the mechanism as I explained it is that losing the fat makes the tissues more often sells more responsive to the insulin when it comes to losing their muscle bulk. We’re talking about overall weight, which you have to be aware of when ever medicines are prescribed generally Okie dokie. That’s kind of what I assumed, but I thought I’d throw it out there just because I know what a challenge. He was, he, he was not an easy patient. I know that type 1002. Jenny type two. He was a type two diabetic, and he was he on insulin? Yes, he was an insulin. Well, that that’s a typical example, isn’t it? That you took the type two diabetic patients? Majority of them are managed with tablets, but some of them to get a better control of diabetes, do end up taking insulin. So that’s something which obviously needs to be addressed, when you get all the the convenience of their insolence and whether it’s required, really I think he was on tablets and injections but that’s right. That’s right, that’s usual, that’s you. Okay, the tablets I initiated to start with in type 2 diabetics and insulin is added, if the control of diabetes is still cool, while they are on tablets or insulin comes usually last. Well, he’s definitely didn’t control it well so, if if diabetes is a bit over treated and we take people off insulin, they still continue on their tablets, usually That’s good to know. Fortunately, he is pretty much. The only older adult I’ve had to deal with that was on medications. Even my paternal grandmother was on much of anything. My mom was not. She was just on the Alzheimer’s medication. So other than my dad took all the medications for everybody, he was on too much money. It’s this he’s a good example of why we don’t we want to take care of our health because the cocktail of pharmaceuticals he was on it was it was a management nightmare to begin with and I have no nobody knows how all that stuff interacted with each other. So do you know I would have loved your dad as a patient there is nothing more. Satisfying for me is to get a patient with a large list of medications and it’s a difficult process, don’t take me wrong. It is not about going there and just cross and every month. Well, it doesn’t work that way, but meticulous review of every medicine indications, the doses, they interactions I feel like Sherlock Holmes, you know, he broke through this medications, finding the connections, deciding whether you still need this or that replacing them, so it can take to do a proper medication review on a complex station can actually take up to 3 hours.
00:15:20 – 00:20:04
Wow. Well if I can find his list of medications, maybe when I don’t know that we still have it but I will send it to you as a definitely I’d love. I’d love to make it to have a look at it. I’ll ask my husband if my husband never gets rid of emails or things so he may have a copy but yeah my dad kept a spreadsheet of what he was on and the doses and off. It was not I’m not into medications. I I prefer to do things as natural as possible when that’s appropriate and I don’t do spreadsheets because I’m an artist. So his friends cheat for his kids was not my favorite so definitely that is that is really helpful information right there. Is that the I don’t have any more questions on the day on the insulin the day betek medications does that lead us into yes blood pressure to blood pressure. Yeah so blood pressure again it’s a very interesting one day not possible without me stopping someone’s blood pressure medications exactly the same story as with diabetes patients, take blood pressure medications throughout their whole lives and strict control of blood pressure prevents kidney disease. Prevent Strokes prevents heart attacks. I cannot emphasize the importance of a tightwad. Pressure control and being compliant with your medications because if you miss a tablet, blood pressure can shoot up and that can lead to an acute stroke. But as long as we grow all their various other things happen in the body and the body responds differently to medications and actually we some medical conditions, the blood pressure goes down itself. So let’s say, you are someone in your 50s. 60s, 70s, benefiting from blood pressure medication. They saved your life. They prolong your life. You now ended up as an eighty ninety year old with memory concerns, you might have Parkinson’s disease and you might be on Parkinson’s medications. And of course we know Parkinson’s and Parkinson’s medications, lower your blood pressure. Did you know that Jenny though? It’s not. Yeah, with Parkinson’s, a lot of patients actually have to low blood pressure down. And there are many other neurological conditions with a heart conditions. If your heart is not pumping properly, that can lead to a low blood pressure. So there are a number of situations where patients benefited from the high blood. Sorry for Brad, blood pressure, lowering medications, but but as they get into their eighties and nineties, exact same blood pressure targets, change. If you are someone in your sixties, your blood pressure Target should be around hundred. Twenty over eighty, especially if you have diabetes. For example, if you are someone in your eighties or nineties, your blood pressure target has changed now dead and in UK nice guidelines, National Institute of clinical Excellence. You might have heard of nice, which helps us doctors in our practice. The target is Honey Pig. 50 over 90. Wow, absolutely why this is done, the reason is simple because all neurological changes in the body home. When we stand up, let me demonstrate this to your journey. It’s very simple to understand. So I stood up now, all the blood is now flashing down, but vet is processes kicking in my body and constrict the blood vessels. My heart is now going a bit faster and all this process has stopped the blood. Pulling down into my iPhone x, and if the blood pools into my legs, what will happen to my brain. There won’t be enough. Blood flowing to the brain and I will collapse. Okay. So did I Collapse? No, I didn’t because I have healthy responses in my body, all my blood vessels are constricted. Now the heart is going a bit faster and the blood is flowing back and continues wage. Using my brain. So these mechanisms this compensation mechanisms in all the adults are altered. Especially if they end up on various medications, if you are a little blood, blood pressure medications are, in fact dilated blood vessels, a lot of heart medications.
00:20:04 – 00:25:06
In fact, slow down your heart rate down. So when they stand up, they don’t have those mechanisms to stop the blood flush and down and they experience dizzy spells. And in some cases, when the blood pressure gets too low wage, you spell can lead to a full fractured hip hospital, admission. And we know what happens to these patients. If especially you are someone quite elderly patient, with memory concerns, I’m sorry to say. It’s, it’s very well-known. The fractured hip could be the beginning of the end. Yep. So dead. Yeah, you’ve been there we’ve discussed this before that is why in all the adults will keep the blood pressure a bit higher. So when you do stand-up and the blood pressure down, it doesn’t go down. Low enough to stop your brain or perfusion or blood. So you are providing a little bit of a cushion. Yeah. And it is always a balancing act, of course, it is a balance in up. You are balancing the risk of a bit higher blood pressure, and risk of stroke, which comes with a higher blood pressure against keeping, the blood pressure on Lower Side. But a risk in a dizzy spell fall and fractured hip Again all of this is coming from multiple clinical research trials which show that low blood pressure, lower blood pressure in a patient’s especially those with memory concerns and dependent on others for their activities of daily living. The so-called normal blood pressure. In fact associated with higher death rates, that is really interesting traditionally, my family Has low blood pressure. Not A problem low, but now I’m, I’m kind of wondering about my paternal grandmother because she always had low blood pressure. I’m wondering. Hm. Curious as to what it was before she died. It’s interesting. But it does remind me of when I started doing the indoor cycle classes and my bottom was killing me from the bike seat. So, I would stand up and your heart just pounds so much harder. Feel like you’re gonna die, so then you sit down and your bottom line. It’s like, but if you wear a heart rate monitor, you can see the difference between standing up and sitting down and transitioning on the monitor. You your blood pressure does change as you stand up or sit down. It’s really interesting. Definitely. It’s interesting. You mentioned the monitors Journey because we the latest guidelines. We bought a fact. Had from nice in 2019 indicated that in all the adults again over the age of 18, especially those with diabetes, we need to track Standing blood pressure. So you need to do line blood pressure and then standing blood pressure because the line blood pressure is one figure and because of all these changes in our body, the standing blood pressure could be too low and then if you treat the line blood pressure, you will get the standing blood pressure, even lower and lead to the dizzy spells and potions. So in an Ideal World, the way I manage, my patience is I will lay them down for 15-20 minutes. I’ll take a blood pressure, then I’ll stand them up for a couple of minutes. Take the block off again, and let’s say the line blood pressure was 180 over a hundred, seems quite a high blood pressure, right. It is very high. Anyone will tell you a very high-end package, it is very easy for that patient to end up on blood pressure medication. But, if I do a stand-in blood pressure, and it drops down 250 over 90. Now, my patient is actually now within the targets for that is 88 plus years old. He has diabetes, might have a little bit of memory problems. He’s dropping his standing blood pressure. It’s hundred fifty over ninety, which is within the targets, acceptable for that patient. So, if I give him blood pressure medications, it will drop even lower, and it will be too dangerous. So that patient with the line blood pressure 180 over a hundred will not be treated. That’s interesting, what you factor in, how sedentary their lifestyle is, cuz I would think, if they were reasonably active for their age, You wouldn’t want to give them the blood pressure medicine because they’re standing blood pressure would be fine.
00:25:06 – 00:30:05
But if they are very sedentary maybe it’s not fine. Well, it’s interesting. You said that. So if I have a very active individual that individual very unlikely to fall in the category of reality we’re talking about, so if that individual more or less sedentary than is probably more than chooses to be, that way, they’re probably problems there. They can’t mobilize purple and so and so that person does have a degree of reality and will benefit from having their blood pressure. Kept on the higher side. It is so individual, a journey, it is so individual. But as a geriatrician, of course, what I’m dealing with day in and day out, false Bulls about 15, I would say, sixty to seventy percent, or presentations to hospital to my ward, my patience with fools. Of course, the Falls are multifactorial can never say, well, it was caused by blood, pressure medicine. It’s contributing the polls are multifactorial. And unless you actually look at every factor which led to the fall, you will not be able to stop them falling and blood pressure medicine, can be just that contributing factor which if we address we might reduce the risk of the fall off. Which we all know is very important. Hm following is just it’s no fun no matter what age you’re at but it’s oh absolutely absolutely. But you see when a full attack quite a older age and you have a degree of memory concerns and prelate a apart from the full. What happens to this individual is Janet. They develop anxiety over future falls off. So that full scares them so much that they deliberately stopped mobilizing. And that’s such a dangerous thing to happen because if you had a full and you are so awful, scared, you stop going out, stop mobilizing, you deconditioned, even more. You lose your muscle bulk, you get even weaker. And you increase the risk of food just by doing that. So long, it’s important not to prevent the falls in the first place number to to address the causes which led to the full do counseling and reassure the individual saying log. You failed because of one, two, three. And look what I’ve done. I’ve corrected this factors so nothing to be scared for go and have a little bit of Rehabilitation, get your physiotherapist to help you to get your balance back and good to go. I just love that. That’s I can see the the relief that an older person would get when you tell them that. Tell that why absolutely my gosh, why? It’s no good saying well you are you are 92. Well what do you expect? Jenny you would not believe. I had a 92 year old patient today and wash, it has Parkinson’s disease and he has swallowing difficulties, which a lot of Parkinson’s patients. Get out. Of course, he has speech problems, he had Parkinson’s for eight years and everybody just sumption. That probably this is deterioration of his Parkinson’s, and then, he was referred to my clinic. And I examined him and it wasn’t until, and he, he kept closing my right eye, and nobody knew why nobody asked him, why? And I said, why are you closing your right eye? He said I’m seeing double. I’ve been having double vision for the last few months. And then, you know, I went more into the history and there is much more going on than just Parkinson’s disease, so every little clue is important. That is just fascinating cuz I love mysteries. And so you’re you’re a solving medical Mysteries which I just love and you’re helping us to learn how to age well and take care of our aging loved ones in a better manners. This is this is super fantastic. I just love. See, I’ve said it before. I learned a lot from you and it helps me process easy going on with aging, loved ones. And it helps me know what questions to ask of my own physician. And, and my husband to ask a his so that we can age well, so that we can get to a hundred and three like my grandmother did. Oh, definitely, definitely. I mean, I’m happy to stop on a couple of blood pressure medications. Do you remember? We wanted to maybe touch off on individual blood pressure medications, which are commonly used and I won’t stop here for too long. But the commonly used medications are the likes of amlodipine. These are cultures General Block West loaded up in Nevada, pencil or deep in the old Jeep in.
00:30:05 – 00:35:01
So and one of the common side effects of these medications is off swelling. And it is very well known side effect. And what do I say, Jenny the patients, develop an ankle swell and they go to see another doctor because in nowaday an age it’s very difficult to to see the same doctor twice, isn’t it? Yes. And they end up on a Buddha medicine for the ankle swollen. So it’s like I say a lot of prescribing Cascades recall them prescribing Cascades, you end up with a medicine, you develop a side effect from that medicine, you go and see your doctor. It might not be the dog who started the first medicine and the second doctor gives you medicine to treat the side effect the first medicine. And so, it goes on and see that every day as long. Also on picking that is important as well. Be well, prescribing Cascades. That’s what happened to my dad, blood pressure medication. The common one is amlodipine all those depends calcium channel blockers colon, causing ankle swelling and patience. Ending up on water medicines. The likes of lays, eggs, gruesome, I’d to treat ankle swelling. What is it, what? How would you treat the ankle swelling from the medicine? Without topic, Jenny, just stop that medicine. Recognized the side effects, stop it, and treat your page with another blood pressure medicine. Got it, okay? Yeah, it’s it’s as simple as that and of course, we have the likes of Ramipril perindopril, they can cause dry cough so that that’s a known side effect of these medications. I mean, the list goes on, they so called beta blockers. Bisoprolol. Carvedilol Atenolol, they’re there to treat, angina. They’re there to treat blood pressure. But in all the patients in all the people, they are very poorly tolerated. They make them feel tired and wage. Really they should be avoided in diabetes and they can make you make your heart, go to slow. So Every single one of them has to be scrutinized, I advise routine medication review. When you are getting to that age, where you have multiple medical condition, seen many doctors ended up on number of medicines and quite a bit of polypharmacy. Find a doctor who can have a look at you holistically take up under their umbrella and do the medicines review for your every six months. That’s not too much to ask, maybe finding the doctor that can be the umbrella. That might be the biggest challenge, can be a pharmacist as well. I think we taught a lot of July’s pharmacist. I mean these are patients, they they it’s a pharmacist know their medicines, they know interactions, even better than doctors do there are a lot of clinical pharmacists out there, whose interests is Paula, Jones Pharmacy, so, it could be a doctor, or pharmacist, or even a nurse there, a lot of specialist nurse prescribers. So, just finding the right specialist for you. So it sounds like you should definitely get to know your your personal pharmacist wherever you have, your medications dispensed. Absolutely. And if you came from home in another physician and ended up with a new medicine, take that medicine and go and see your nurse pharmacist or primary primary care. Doc, sit down and look at all your other medications and make sure that there are no interactions. Because the doctor will prescribe that medicine, it could be a single organ specialist. He’s only seen his organ, whether it’s a heart kidney stones, so they won’t have the time to go through your other twenty medications. So you need someone to do that work for you. So that’s really good advice because I think home with digital medical records that all of the doctors and hospitals etcetera can access about you. Although that never seems to be a hundred pages. Accurate. I believe, most people think. Well, they’re looking at everything I’m taking. So this must be fine and you’re saying, no, you need to make sure that anything new month. You run it past your pharmacist your general physician. I think that’s excellent. See, there’s that tidbit that everybody needs to keep in mind. Yeah, at tip. Yeah, I hope so. Now we’re going to go on to get dementia medications. Dementia medications, yes, very important. And that is why I left it to the last. Usually, you see, we’re in like, in discussions like this place.
00:35:01 – 00:40:09
You remember the last Point, don’t you? That is true. The retention of the information. I read statistics somewhere that in the first our way, you sort of remember 50% off by the end of the week. It’s only 10% of the information, anyhow. So dementia medications. A lot of our patients with dementia are taking dementia medications and log Like to take a minute to explain what exactly they do. So a chemical messenger in our body called acetylcholine cause he’s responsible for memory and learning acetyl choline. So it’s a chemical messenger and the current treatment around dementia is based on Boost the amount of a satirical line in the brain. So the likes of Aricept and we will just use our except, or do an appraisal. Very commonly used dementia medication, as an example, the June of this medication is to boost the amount of our still Coraline. It is doing so by inhibiting the enzyme, which metabolizes are still Coline. So that’s what it does, what we now need to discuss is that there are so many medicines out there, which have completely opposed in mode of action. They work by reducing the amount of acetyl column in the body. And Johnny, I’m coming to it now. How often do you think? I, I spoke to mention Medicare dementia patients, patients with dementia, coming to hospital. You look at their drug chart and they are all now recept. Which increases the amount of are still Coraline on the brake and underneath our, except is a medication, which reduces the amount of us, still whole line on the brain completely opposing modes of action. And you instantly know that God has done the prescription. Maybe clinical pharmacology wasn’t their strongest part in medical school. Shall we say? That sounds like a positive way of putting it. This happen wage. Too often and of course in the world of dementia Specialists, we know that we should those medications which reduce the amount of are still cool line. They are known as anticholinergic medications and you might have come across that term and it is very well-known fact that anticholinergic medications should be avoided in patients this memory concerns if possible to land in our day and age we have many other Alternatives, sometimes it might be impossible to avoid them as long as we don’t end up. Prescribing several of them. So the name commonly used ones in our population are the continents medicines and we discussed continents with you a few weeks ago. So off the medications which are used to call to treat, overactive, bladder, incontinence problems or incontinence problems. In fact have anticholinergic side effects They suppress the amount of us still call line and should be avoided in all the patients, but they’re very commonly prescribed along with our, except which increases the amount. So the box which I used four continents and a lot of our listeners might recognize these are tolterodine oxybutynin, very Finessin, Sawadee venison, there are others, but these are the most commonly used ones. And of course, Jenny. They, some of them are newer than the others. And the pharmaceutical companies will tell you that, the, the drug does not cause confusion there drug does not cross blood-brain barrier and more specific for the bladder. What they forget is in their clinical trials, how many nursing home patients, did they recruit into their clinical trials? For suffer with various degrees of dementia? Our My day today patients are not represented in those clinical trials. Also, these medicines might not cause confusion on their own, but with just discuss our patients end up with many medications, which might also have that anticholinergic side effect. So when they’re combined all together, I’m sorry to say they do cause confusion and once, or twice a year journey, I cure dementia. How often do you think as a geriatrician IQ? Anyone pleased to accept I look after patients in their nineties and they’re very late. Nineties, hundred year olds, we have to be realistic in my clinical practice, a lot is about making their life, easier improving their quality of life, and making it a bit tolerable for them to write few conditions, where I can claim I pure them, But there are very few.
00:40:09 – 00:45:01
So once or twice a year when I do a thorough medication review and take my patient with dementia off, all those anticholinergic medications suddenly, it turns out that they don’t actually have Dimension or they had only mild Dementia or mild cognitive impairment, but the medications made them so bad at that they came across as having quite a severe dementia. So that’s how important it is. And when we’re talking about anticholinergics are usually attached or memories, they have many other side effects which are can be very upsetting urinary retention, constipation. Dry Mouse is really bad one as well. So that’s really bad side effect, very bad side effects. Yeah. And reduced eating and drinking. You know, if you have dry mouth, you might not have appetite. You might not be able to eat your food properly, so I can go home. About anticholinergics. But my God I cannot emphasize the importance or looking at anticholinergic burden in patients and kinetic. Burden in terms of took lessons in patience was memory concerns especially those who are in fact on the likes of our recent. So do not look at individual medication. Look at the overall burden, there are other important anticholinergics which are I our patients with dementia end up using is amitriptyline. Nortriptyline, these are all freshened antidepressants with quite potent, anticholinergic properties, making people confused. So this I thought I’ll mention this to, but a lot of medications, which we use might have mild anticholinergic properties. Like, Warframe, who would have thought digoxin used for heart condition? Even the water Medicine phone number Semi, you know, they all have. So when you end up on number of those suddenly, even though every single one have just mild anticholinergic side effect amalgamation off, the Lord becomes too much for that brain and people will confuse them with think that they’re demented. That’s amazing. It’s interesting, my husband ended up with blood clots in his lungs. Two years ago, almost two years ago, they don’t know what caused them, and he was on Warfarin for a long time. And now I’m wondering I’m going to have to think back and see. He doesn’t remember a lot about that time. He seems to have like slight gaps and now I know why, cuz it just affected him cuz he was on pretty high dose for a while cuz he’s a big guy that’s he’s going to be, I’ll have to make him. Listen, I have one question regarding the, the Alzheimer’s medication and I can’t remember the name of it. I’m terrible. But you mentioned, it are. Except the nausea pill. Is that the other one is the same as the dementia medication. Aricept is a brand name for donepezil wage. Okay, same things. Okay, but there is also rivastigmine. There are three of them which we use on a galantamine and rivastigmine, and democracy are the three, most authors. Dementia medications, which were using. Is there any truth to the? I have read and I’ve been told that about after five years of being on that medication, they they need to be re-evaluated because sometimes it makes the not the symptoms, but the it makes a lot of what’s going on with the Alzheimer’s progression, actually worse and sometimes taking them off of it as better. But, when I asked my mom’s neurologist about that, she told me know, that wasn’t true. So I’m not sure what to believe. Is it individualized like everything else? Well, no Jenny I’d say that’s not true, it’s not making that dementia symptoms were. So let me try to break it into off. Your question is quite interesting. So again here in UK we’re using the iris app, Apostle for mild to moderate dementia home. When the person moves into the later stages of dementia, the severe dementia, they develop behavioral problems. They don’t episode doesn’t appear to be that useful anymore. It does affect dementia worse. It just becomes useless. It’s just an extra pill. You are taking for no good reason, it’s not helping you anymore. So we tend to switch from the Napa. So to my mountain mountain, is another dementia medication and he cable using it for severe dementia.
00:45:01 – 00:50:00
Especially in patients, with behavioral problems. Some patients can be on both phones. Brazil and memantine, let’s say, bad. Dementia is not that bad, but they already have behavioral problems. The mountain show has shown to help that. So they might be on both so long. They develop make dementia symptoms wise, they just stopped working. And when you come to the last stages of dementia, when the patient is entering their end-of-life care stages of their disease, with all this medication should be discontinued anyway. So I think that’s that, that’s what’s happening and let’s face, it don’t matter has L it’s a medication. As I said, it increases the amount of us still Coraline on the brain and by doing, so I got it on its own side effects, it’s causes upset stomach. It can cause diarrhea, it can make your heart full slow. And again, once or twice a year or something, my dementia patient’s actually end up with pacemakers Journey because I still want to give them medicine, but it makes the heart to go too slow. So I have to put a pacemaker to get the heart going so I can continue the medicine. So we need to be aware of this side effects. My goodness, it’s definitely complicated. Oh, it is very it’s fascinating, but at the same time that is true to. Like I said, I’ve learned so much and it’s, you know, you’d think. Oh, why would I want to listen to Somebody? Talk about, you know, medications and older adults. And it’s dead. This is why cuz you learn things that maybe you need to know right now. Maybe you need to know later on well and I will listen is there will be so many with the love with their loved one be having dementia and having a for example being on a dementia medication. This knowledge of knowing that dementia medication can make the heart to slow and slow heart bit slow it can cause dizzy spells can cause low blood pressure. It can make their loved ones to have recurrent Falls and being a bit more model, they would know why. And as I said as simple, I am. ECG electrocardiogram will show that what we call bradicardia slow, heart rate, and will lead to diagnosis. And there is a remedy, is Annette, there is a remedy month, you do a pacemaker if the person can tolerate it a horse and, or if you can’t do a pacemaker with stopped on episode. Donepezil and give them a month club. Start, which doesn’t have those side effects. So very important to know. I mean, I say I don’t know whether you’ve seen my YouTube channel Jenny, but it’s called be your own doctor. And I will be very happy if you put a link somewhere to my YouTube channel there, because at least designed for our listeners, it is not for obvious, it’s not for medical professionals. It is for people to understand their medicines, and I’m teaching be your own daughter. So, we’ll definitely link that in the show notes, and you’ll be able to watch this on YouTube and we’ll I’ll have the editor, fix it, so they can click over to your episode. I’ll ask anyway, I’m not good at that. So I don’t know if that’s an option between channels but we’ll see what we can do. Definitely be linked in the show notes so people can go find it and I know there’s lots of interesting topics that your Tech covering over there because if you’re not following Elena on Instagram you are missing out on some very quick, easy digestible information, on all things for older adults aging. Well, that’s how we found each other and I’m always fascinated by everything that she’s posting. Thank you, thank you. I applaud any doctors in the US doing Tik-Tok in Instagram reels She’s the hip doctor. So is there any last-minute last bit of information on medications before I let you go into the evening? I want to share with you a story of a patient I saw today. So you can have dementia and you can be beautifully controlled on your medications. I took him two years ago for a Journal Review and nothing’s wrong with him. His family requested, another of you two years later just to make sure everything is fine. And there has been a was eighty-six and he’s eighteen now. There has been no decline whatsoever. So with dementia medications, the research is quite clear. We do not expect a dramatic Improvement, we have to be honest about it. We have to be honest, with our listeners, having your loved one on dementia medication, doesn’t mean that they’re suddenly going to be.
00:50:00 – 00:52:53
In fact, normal, dementia medications, do not do that. Their job is maybe to improve your a little bit, but the main job is to slow down the progression a little bit and it’s dead. Amazing job in this individual. I was delighted to see him look and really well, and having a tennis match plant with his some, for the afternoon. Oh, that is wonderful. Tennis of 88 is a. That’s a goal. We should all strive for or so. I asked you some to go easier on his dad lived Edwin, it’s yeah. That is wonderful. And that sounds like a beautiful place to stop for today. Do we know what we’re talking about? Next month? I don’t see any that’s okay. We will figure it out before we record again. So I really appreciate this all the listeners. Definitely check out. Doctor Moochie’s YouTube, channel, or Instagram account. You will not be sorry that you did that. Thank you, thank you very much. I can’t improve upon that last story knowing that someone can maintain reasonable cognitive skills because of medication and lifestyle. Choices long is the entire reason that I do these episodes with dr. Elena and provide you with, as much brain health and aging, well episodes that I feel I can squeeze in. I looked it up our next conversation is on preventing dementia. So you definitely going to want to check that out. And again, as I mentioned faith in the beginning, if you want to place to go and ask questions and get honest answers from me or people like dr. Elena definitely pop over to my Facebook page and make a post that says I’m in. And I’m really hoping that we can grow a supportive community, that really shares. Good answers and has nice. Text conversations about the week’s topic. If this isn’t something you’re interested in, not a problem, but definitely be sure to follow me on Instagram because I share a lot of cool stuff over there. Including some dog photos cuz you know, we all have to have a timeline cleanse with fun dog photos and I have adorable golden retrievers so you gotta gotta share them right off next week. Start season 4 of fading memories. I have a lots of great topics already lined up for you. And, you know what that means? Once again I’ll be in your ears again next Tuesday.