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Medicine and Cognition

Sunday May 18, 2014

Cognitive problems, namely executive dysfunction is common in Parkinson’s disease. Medicines, of course, can worsen cognition including memory. Although dopaminergic medicines are the most commonly used medicines to treat PD motor symptoms, there are many others to be aware of as they too can cause thinking problems.

The following discussion lists medications by categories of use followed by examples that can cause problems.   

Parkinson’s Movement
  • Dopamine Medicines- Used to treat all movement symptoms associated with PD, these medicines can worsen cognition in some patients. Different people will react differently to each medicine but the following class of medicines has a greater risk:
    • Dopamine Agonists- Ropinirole (Requip), Pramipexole (Mirapex) and Rotigotine (Neupro)
    • Amantadine
  • Anticholinergic Medicines- These anti-tremor and dystonia medicines are used less frequently due their cognitive side effects.
    • Trihexyphenidyl (Artane), Benztropine (Cogentin)
Sleep

Sleep medicines, or sedatives, can cause daytime grogginess and confusion. Examples of common sleep aids include:

  • Zolpiden (Ambien), Zaleplon (Sonata) and Eszopiclone (Lunesta) – The FDA recently recommended using lower doses of these medicines due to these problems.
  • Diphenhydramine (Benedryl, Tylenol PM, many allergy preparations) - Yes even over the counter medicines carry risk of cognitive problems.
  • Clonazepam and other benzodiazepines such as diazepam (Valium), alprazolam (Xanax), lorazepam (Artane) - These medicines are used for their sedating effect or REM Sleep disorder (Clonazepam).
Pain
  • All narcotics such as Oxycodone (Percocet, OxyContin), Vicodin (hydrocodone), Morphine, Tramadol (Ultram) carry high risk of confusion and related cognitive problems
  • Anti-seizure medicines Gabapentin (Neurontin) and topiramate (Topamax) and antidepressant amitriptyline are examples of medicines used for chronic pain.
Anxiety
  • Clonazepam and other benzodiazepines such as diazepam (Valium),  alprazolam (Xanax), lorazepam (Artane)- These medicines are used for their anti-anxiety effects.
  • Alcohol and medical marijuana can cause long acting memory problems
Muscle Relaxants

Muscle relaxants such are sometimes used to treat muscle spasm, rigidity and dystonia. Examples include:

  • Benzodiazepines
  • Baclofen (Lioresol), Tizanadine (Zanaflex), cyclobenzaprine (Flexeril),metaxalone (Skelaxin)
Bladder Medicines

There are different types of medicines designed to treat different types of bladder medicines. In general, medicines designed to treat overactive medicines can cause cognitive changes.

  • Oxybutynin (Ditropan), solifenacin (Vesicare), Detrol (Tolterodine), Fesoterodine (Toviaz)
Drooling

Medications such as patches, pills and drops are sometimes used for drooling but can cause cognitive and memory problems

  • Tricyclic antidepressants - imipramine and amitriptyline
  • Glycopyrrolate (Robinul)
  • Scopolamine
  • Atropine drops

Note: The examples above do not represent a complete list. Be sure to discuss all your medicines and side effects with your healthcare provider and do not stop or start medicines without medical supervision.

Monique L. Giroux, MDMonique L. Giroux, MD
Medical Director, Northwest Parkinson's Foundation

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