Some medicines are linked to confusion, memory problems, or a higher observed risk of dementia, especially in older adults. The strongest concern is often the total anticholinergic burden from several medicines taken over time, according to the National Institute on Aging. This guide shows 8 medication types to review carefully and how to discuss them safely with a doctor or pharmacist.
Hands checking an over-the-counter allergy or sleep aid package.
1
Check older antihistamines and PM sleep aids
Read allergy, cold, nausea, motion-sickness, and PM sleep labels for ingredients as diphenhydramine, doxylamine, chlorpheniramine, meclizine, hydroxyzine, or promethazine. The 2023 AGS Beers Criteria lists first-generation antihistamines as highly anticholinergic and warns that cumulative exposure is associated with confusion, falls, delirium, and dementia. Ask about safer options if you use them often for allergies or sleep.
Warning:
Do not stop a prescribed medicine just because it appears in this guide. Use this list to start a medication review with a doctor or pharmacist.
Older adult asking a pharmacist about a bladder medicine.
2
Review overactive bladder medicines
Look for bladder medicines such as oxybutynin, tolterodine, solifenacin, darifenacin, fesoterodine, or trospium. A large nested case-control study found dementia-risk associations with several strong anticholinergic drug groups, including bladder antimuscarinics. If you take one, ask whether the benefit still outweighs the risk and whether non-drug measures or lower-anticholinergic options fit your situation.
Patient reviewing an antidepressant medicine with a doctor.
3
Identify strongly anticholinergic antidepressants
Some antidepressants, especially older tricyclic medicines such as amitriptyline, imipramine, clomipramine, and higher-dose doxepin, can add a strong anticholinergic effect. The same JAMA Internal Medicine study reported anassociation between anticholinergic antidepressants and later dementia diagnosis. Do not stop an antidepressant abruptly; ask the prescriber whether your dose, diagnosis, and alternatives should be reviewed.
Clinician discussing an antipsychotic medicine review with an older adult.
4
Ask about antipsychotics and dementia-related behavior
Antipsychotics may be necessary for certain psychiatric conditions, but they need careful monitoring in older adults. The AGS Beers Criteria warns that antipsychotics are linked with increased stroke risk, faster cognitive decline, and mortality in people with dementia, and recommends avoiding them for dementia-related behavior unless non-approaches have failed and safety is at risk. Ask whether there is a clear reason, a monitoring plan, and a regular attempt to use the lowest effective dose.
Neurologist reviewing a Parkinson’s medicine with an older patient.
5
Review Parkinson’s anticholinergic medicines
Medicines such as benztropine and trihexyphenidyl may be used for Parkinson’s symptoms or medication side effects, but they can be hard on memory and thinking in older adults. Research on strong anticholinergic exposure found dementia-risk associations with antiparkinson anticholinergic drugs. Because Parkinson’s treatment is specialized, any changeonly with the prescribing clinician or neurologist.
Caregiver setting aside a seizure or nerve-pain medicine for review.
6
Flag seizure and nerve-pain medicines for review
Some medicines used for seizures, nerve pain, or mood stabilization can affect alertness, balance, or cognition, and some antiepileptic drugs appeared among the anticholinergic classes associated with dementia risk in the large case-control analysis. These medicines can be essential, and stopping suddenly can trigger serious problems such as seizures. Ask whether your medicine has anticholinergic or sedating effects and whether monitoring or a safer substituteis appropriate.
Hands reviewing stomach and motion-sickness medicines.
7
Look for stomach, bowel, or motion-sickness anticholinergics
Medicines for cramps, irritable bowel symptoms, nausea, or motion sickness may include anticholinergic drugs such as dicyclomine, hyoscyamine, scopolamine, or promethazine. A Cochrane review found low-certainty evidence linking anticholinergic burden with future cognitive decline or dementia, so the total load matters even when each medicine seems small. Ask whether short-term use, a different treatment, or non-drug steps could reduce exposure.
Older adult discussing sleeping pills with a doctor.
8
Review benzodiazepines and Z-drug sleepingpills
Check for benzodiazepines such as alprazolam, lorazepam, diazepam, clonazepam, or temazepam, and Z-drugs such as zolpidem, zaleplon, or eszopiclone. The Beers Criteria says these drugs can raise the risk of cognitive impairment and delirium in older adults, while an umbrella review of benzodiazepine studies found limited and weak evidence for a dementia-risk link rather than proof of causation. If you use them for sleep or anxiety, ask about a taper plan and safer long-term strategies.
Older adult bringing a complete medication list to a doctor and pharmacist.
9
Bringthe full list to a doctor or pharmacist
Make one list of prescriptions, over-the-counter products, supplements, doses, and how often each is used, then bring it to every medication review. The National Institute on Aging recommends telling health professionals about all medicines because mixing drugs and supplements can be dangerous. Seek medical help for sudden confusion, and discuss worsening memory with a professional, as the CDC recommends for adults with confusion or memory loss; MedlinePlus also notes that confusion can have many medical causes.
Important:
This article is for generalinformation only and is not medical advice. Talk to a doctor or qualified health professional about your own situation, especially before making changes to medication, treatment, or care.
Key Takeaways
The bottom line: do not panic over one medicine name, and do not stop treatment on your own. Make a complete medication list, look for anticholinergic or sedating medicines, and ask a qualified health professional whether each drug is still needed, whether safer options exist, and how any change should be made.
Frequently Asked Questions
Do these medicines definitely causedementia?
No. Much of the evidence is observational, so it shows a link rather than proof that a medicine directly causes dementia. The concern is strong enough that older adults should review these medicines with a clinician, especially when several are used together.
Which medicines are the biggest concern?
Medicines with strong anticholinergic effects are a major focus, especially when used regularly or combined with other anticholinergic drugs. These can include some older antihistamines, bladder medicines, antidepressants, antipsychotics, Parkinson’s medicines, seizure medicines, and stomach or bowel antispasmodics.
Are over-the-counter aids included?
Yes, some common nighttime or PM products contain older antihistamines such as diphenhydramine or doxylamine. These can cause confusion and other anticholinergic effects in older adults, so routine use should be discussed with a doctor or pharmacist.
Should I stop a medicine if it appears on this list?
No. Stopping suddenly can be dangerous, especially with medicines for seizures, anxiety, sleep, mental health, or Parkinson’s disease. Ask the prescriber whether the medicine is still needed and whether any change requires a slow taper or monitoring.
What should Ibring to a medication review?
Bring every prescription bottle, over-the-counter medicine, sleep aid, allergy medicine, supplement, and as-needed product you use. Include how often you take each one, why you take it, and any confusion, dizziness, falls, sleepiness, or memory changes you have noticed.
When is memory trouble urgent?
Sudden confusion, severe drowsiness, new disorientation, hallucinations, a fall, or a big change after starting a medicine should be checked promptly. Gradual or worsening memory problems should also be discussed with a health professional so treatable causes can be considered.
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