The headline in the image says that a medicine can “destroy the brain” and cause serious dementia. That wording is far stronger than what medical evidence supports.

There are medications that can cause confusion, drowsiness, memory problems or other cognitive side effects, particularly in older adults. Some medication classes are also associated with an increased risk of dementia in observational studies. But it would be misleading to say that these medicines simply “destroy the brain” or that taking one automatically causes dementia.

The risk depends on the specific medication, dose, duration, age, other medical conditions and other medicines being taken at the same time.

The American Geriatrics Society’s 2023 Beers Criteria identifies a number of medication classes that can be particularly problematic for adults aged 65 and older, including several drugs with anticholinergic or sedating effects. The criteria are intended to help clinicians weigh potential risks and benefits rather than tell every patient to stop a medication. (AGs Journals)

Here are eight medication groups worth knowing about.

1. Strong Anticholinergic Medicines

Anticholinergic medicines are among the most important groups to understand when discussing medications and memory.

These medicines block the action of a neurotransmitter called acetylcholine. Acetylcholine is involved in memory, attention and other nervous-system functions.

Some anticholinergic medicines can cause:

Dry mouth
Constipation
Blurred vision
Drowsiness
Confusion
Difficulty concentrating
Memory problems

These effects can be particularly noticeable in older adults.

Examples of medicines with strong anticholinergic properties include some older antihistamines, certain bladder medications and some antidepressants.

The problem isn’t limited to one particular drug. It can also be the combined anticholinergic burden when a person takes several medications with these properties.

The 2023 AGS Beers Criteria specifically identifies highly anticholinergic medications as potentially inappropriate for many older adults because of their association with cognitive and other adverse effects.

An important warning

Don’t stop a prescribed medication simply because you see its name on an internet list.

A medication may have been prescribed because its benefits are important for a particular medical condition.

Instead, ask your doctor or pharmacist:

“Could any of my medicines be contributing to my memory or concentration problems?”

A medication review can sometimes identify safer alternatives or unnecessary duplication.

2. First-Generation Antihistamines

Many people assume that all allergy medicines are essentially the same.

They aren’t.

Older, first-generation antihistamines can cross into the brain and may have significant anticholinergic effects.

Examples include medications containing ingredients such as:

Diphenhydramine
Chlorpheniramine
Hydroxyzine in certain contexts

These medicines can cause drowsiness and impaired alertness. In older adults, they can also contribute to confusion and other cognitive problems.

This is one reason the Beers Criteria recommends avoiding many first-generation antihistamines in older adults when possible.

Why are they sometimes overlooked?

Some are available without a prescription.

That can create the impression that they are harmless.

But over-the-counter does not mean risk-free.

Older adults should be especially careful about taking these medicines regularly for sleep, allergies or cold symptoms without discussing them with a healthcare professional.

A pharmacist can often help identify whether an alternative with fewer cognitive effects would be appropriate.

3. Benzodiazepines

Benzodiazepines are medications commonly prescribed for anxiety, panic disorders, insomnia and certain other conditions.

Examples include:

Diazepam
Lorazepam
Alprazolam
Clonazepam
Temazepam

These medicines can be effective for specific conditions, but they can also cause sedation, impaired coordination and cognitive impairment.

The risks become particularly important in older adults.

The American Geriatrics Society recommends avoiding benzodiazepines in older adults in many circumstances because of risks including cognitive impairment, delirium, falls and fractures.

Research examining benzodiazepines and dementia is complicated, too.

Some observational studies have found associations between benzodiazepine exposure and dementia, but association does not necessarily prove that the medication directly caused dementia. Underlying anxiety, insomnia or other health conditions can themselves be associated with later cognitive problems.

For example, a 2023 cohort study of adults aged 65 and older found associations between sustained benzodiazepine use and incident dementia in some age groups, but the researchers also emphasized the difficulty of separating medication effects from underlying conditions. (AGs Journals)

Never suddenly stop a benzodiazepine

This is especially important.

People who have been taking benzodiazepines regularly may develop physical dependence.

Stopping suddenly can cause withdrawal and, in some cases, serious complications.

If you take one regularly and are concerned about its effects, speak with your doctor about whether a gradual taper is appropriate.

4. Certain Antidepressants With Strong Anticholinergic Effects

Antidepressants are not one single type of medicine.

There are many different classes, and their effects on cognition can vary substantially.

Some older antidepressants, particularly certain tricyclic antidepressants, have strong anticholinergic properties.

Examples include:

Amitriptyline
Imipramine
Clomipramine
Doxepin at higher doses

The 2023 Beers Criteria identifies certain strongly anticholinergic antidepressants as medications that are generally best avoided in many older adults. (AGs Journals)

This doesn’t mean antidepressants cause dementia.

It means that some specific antidepressants can create problems such as: