Here’s a list of very commonly used medications which have been associated with an increased dementia risk ( not causal).
https://www.goodrx.com/conditions/dementia/these-drugs-could-increase-your-risk-of-dementia?utm_medium=email&utm_source=bz&utm_campaign=weekly&utm_content=c4fd7cc4-2a70-4ef6-98e1-9fb78cd26a14&utm_term=Jun-15-23
In the average person the risk may not be significant, but in the genetically at risk it may be wise to seek alternatives.
For instance, pepcid could be used instead of the PPI’s for reflux. Tylenol under 3-4 grams per day instead of NSAID’s .
Palmitoylethanolamide and quercetin are both mast cell stabilizers and can work as well as the antihistamines but without the anticholinergic effects.
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Instead of forgoing NSAIDs completely, diclofenac or fenamates (flufenamic acid and mefenamic acid) could possibly be considered for use instead of naproxen or ibuprofen.
“More recently, protective effects of diclofenac and NSAIDs in the fenamate group have been reported. Diclofenac decreased the frequency of AD significantly compared to other NSAIDs in a large retrospective cohort study. Diclofenac and fenamates share similar chemical structures, and evidence from cell and mouse models suggests that they inhibit the release of pro-inflammatory mediators from microglia with leads to the reduction of AD pathology.”
“Diclofenac, which has been shown to have active transport into the central nervous system, and which has been shown to lower amyloid beta and interleukin 1 beta, is associated with a significantly lower frequency of AD compared with etodolac and naproxen.”
“Patients with OA might have a higher risk of dementia. Both etoricoxib and diclofenac might lower the risk of dementia in patients with OA.”
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Very interesting. Wasn’t aware of the lower AD risk with diclofenac. The cardiovascular risk might still be a concern as with all NSAID’s.
I like diclofenac gel for actinic keratosis.
KarlT
#4
Correct me if I’m wrong but does most or all of this data come from observational studies? And if so, how reliable is that?
You’re absolutely right, the evidence is correlation and not causal, so needs to be taken with a large grain of salt. I’d say the strongest evidence is with antihistamines due to the anticholinergic component.
Over-the-counter sleep aids linked to dementia (medicalnewstoday.com)
I’m a bit biased here since I was the medical director of a large geriatric health care facility for many years and witnessed ALOT of dementia cases. It’s devastating for the patient and family both.
So my general stance is when you have even a mild risk of a severe disease, you don’t take that risk unless absolutely necessary. Try to find other options and you may have to explore those options on your own. I’ve expressed similar views when it comes to statins.
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AnUser
#6
Yes, if someone was very worried about Alzheimer’s disease, then they could be cautious about any medication having association with alzheimer’s or dementia. Cognitive decline is terrible.
At the same time, there has to be a strategy for lowering apoB to low levels, as it’s all just pointless if one gets atherosclerosis - decreased blood flow, and die from heart disease. It also decreases quality of life to get heart attacks, decrease in blood flow, also increase risk of vascular dementia. That to me suggest hydrophilic statins as they don’t cross the BBB as easily, but obviously for someone who can afford it, PCSK9 inhibitors or the newest siRNA inhibitors inhibiting PCSK9. I would take those if they were generic. I don’t trust supplements unless they are proven to be safe. But so far I think my strategy is going to consist of hydrophilic statins for lowering apoB, diet and lifestyle aside. If someone knows other strategies than hydrophilic statins, PCSK9 inhibitor via antibodies or siRNA I would like to hear it. (apoB around 60 or lower).
It is a bit more complex than you are making it sound. This below is a very informative video lecture on lipids and dementia. Especially lowering cholesterol lowering strategies with statins are a mixed bag and in certain cases provide no benefit or can even make cognitive impairment worse. So even taking statins as primary ASCVD prevention without knowing the complexity of risk factors might expose you to cognitive impairment and dementia. Hydrophilic statins work both lowering cholesterol peripherally and in central nervous system.
https://www.lipid.org/media/journalclub/selaspeaks04/
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Every two and a half months medical knowledge doubles. Nothing is simple. Even discussing atherosclerosis is complicated. We’ve known for a long time that endurance athletes have more plaque but this was believed to be the more stable variety. Not so. They have more atherosclerosis in general encompassing calcified, mixed, and even the most dangerous soft plaque, It’s even on the most dangerous proximal areas.
Lifelong Endurance Exercise and Coronary Atherosclerosis - American College of Cardiology (acc.org)
It’s even being suggested that we limit our exercising to 3 or less hours per week. Yet, this group still lives longer!
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There is a good article on exercising and longevity. Probably as in everyting in life, the key is the balance.
Summary
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Physical fitness is the single best predictor of life expectancy and healthspan. Try to achieve and maintain a high level of physical fitness throughout life.
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More is better for moderate-intensity exercise with respect to CV health and life expectancy. Vigorous exercise is also beneficial for optimizing life expectancy and healthspan, but maximal benefits are achieved at 150 minutes/week.
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HIIT is a time-efficient strategy for attaining and maintaining high-level CRF. Regular participation in team sports or other forms of physical interactive play is associated with good mental health and longevity.
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Shoot for at least two hours/week spent outdoors in natural settings (green spaces or blue spaces). Gardening and adopting a dog are practical strategies for accomplishing this goal.
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Aim for two sessions/week of strength training for a cumulative time of about 40 to 60 mins/week, ideally not exceeding 150 mins/wk.
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Incorporate flexibility and balance training sessions like yoga or tai chi.
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Allow ample time for rest, relaxation, recovery, and sleep after strenuous exertion
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KarlT
#11
Long-Term Cognitive Safety of Achieving Very Low LDL Cholesterol with Evolocumab
https://evidence.nejm.org/doi/full/10.1056/EVIDoa2400112
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Conclusions
Exposure to very low levels of LDL cholesterol, achieved via PCSK9 inhibition and statin therapy, was not associated with cognitive impairment through long-term follow-up. Further studies are needed to assess the generalizability to adults at higher risk of dementia.
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