Medicines and dementia risk

[AliDeJ]

Hello. I'm 64 years old with a painful back problem (lumbar spinal stenosis, spondylosis and spondylolisthesis). While I wait for an appointment at the Pain Clinic, I was recommended by the musculoskeletal specialist to try a drug called gabapentin. My doctor put me on another from this group of drugs called Amytriptoline. I have definitely noticed an improvement. I have been taking it for nearly three weeks. However. it seems to be linked to dementia which worries me. I have been taking lanzoprazole for 7 years as well, and naproxen, both of which also are linked to dementia. Is there a painkiller which isn't? Are all ppi's risky in this respect? I'm also taking tocilizumab injections weekly and am now on 7.5 mg prednisolone. I would be grateful for your experience of dementia risk medicines and less risky alternatives. Thank you.

[piglette]

I am afraid it is not in our remit to recommend drugs to you, we are not medically qualified individuals. We can comment on how certain drugs have affected us and others. We can also tell anecdotes, but when it comes to suggesting certain pharmaceuticals that is up to your doctors. One thing it is recommended not to take NSAIDs such as Naproxen with steroids for any length of time.

[AliDeJ in reply to piglette]

Thank you. Sorry if my query is out of order.I just hoped someone would say " I'm taking x or y for the same problem and there's no warning about dementia ." Thank you for the tip about Naproxen.

[AliDeJ in reply to piglette]

Hi Piglette. May I ask why Naproxen and steroids should not be taken together for a long time? Is it because both potentially affect the stomach, or something else?

[piglette in reply to AliDeJ]

Yes. Combining NSAIDs and corticosteroids can increase your risk of developing such things as stomach ulcers, inflammation, internal bleeding and also rarely perforation.

[PMRpro Ambassador]

If you refused all the drugs that have associations with dementia - you probably wouldn't take much! The PILs have to list everything that might cause something and they can sound pretty awful.

This is an interesting discussion I think - and it mentions that the studies were observational so don't establish causation, just association.

health.harvard.edu/mind-and...

I think you need to sit down with the doctor and ask what alternatives are available to you and what the risks really are. Some of the risk depends on how long you need to take them and you also have to consider the benefits of you taking them.

[AliDeJ in reply to PMRpro]

Thank you, PMR pro. I could not access the link though. It said DNS address not found.

[PMRpro Ambassador in reply to AliDeJ]

Strange - neither can I now and that is using the result in the search! Nor is another Harvard.edu link.

OTOH, this

ncbi.nlm.nih.gov/pmc/articl...

illustrates my comment about the number of drugs being "associated" with dementia. But correlation is not causation ...

[AliDeJ in reply to PMRpro]

Thank you so much. This article made an interesting read.

[AliDeJ]

Thank you, both, for your insightful replies.

[AtopicGuy]

Please see the well-sourced link below.

There are lots of uncertainties in all epidemiological studies like these. If they were to come up with increased (relative) risk factors like doubling (200%), or trebling (300%), or 10x (1000%, then it would obviously be worrying and the drugs would stop being prescribed. But this one is nowhere near that. It suggests between 6% and 49%, depending on age, family history, which disease(s), which drug, the level of dosage, the duration of the treatment, etc. etc. etc.

The total (absolute) increase in risk also depends on the average risk of developing the disease in the first place. An increase of 6 to 49% would mean:

A 1 in 20 chance would increase to between 1 in 19 and 1 in 6.5 at very worst;

A 1 in 200 chance would increase to between 1 in 189 and 1 in 134 at very worst;

A 1 in 20,000 chance would increase to between 1 in 18,868 and 1 in 13,423 at very worst.

The highest starting-chance of developing dementia obviously applies to those who have already lived long lives and are now very elderly. The chance of early-onset dementia is much, much lower to begin with.

I'm not a betting man, but those remain very good odds in the patient's favour at every level! I have taken some of these drugs for many years and am not concerned in the slightest.

news.joindementiaresearch.n...

[AliDeJ in reply to AtopicGuy]

Thank you Atopic Guy. You certainly have a head for maths! Your conclusions are reassuring.

[AtopicGuy]

You're welcome. I used to teach maths.