Senior Dementia Patients in Nursing Homes See Faster
Decline if Given Incontinence Drugs
A significant problem because an estimated 33% of
people with dementia also take a drug for incontinence
April 30, 2008 – Older nursing home residents who
took medications for dementia and incontinence at the same time had a 50
percent faster decline in function than those who were being treated
only for dementia, according to a study from researchers at Wake Forest
University School of Medicine and colleagues.
“It is likely that the oppositional effects of the
drugs contributed to the accelerated decline,” said Kaycee M. Sink,
M.D., M.A.S., lead author. “Over a year’s time, the decline we observed
would represent a resident going from requiring only limited assistance
in an activity to being completely dependent, or from requiring only
supervision to requiring extensive assistance in an activity.”
The combination of drugs affected older adults who
started out with higher levels of function in activities of daily living
such as dressing, personal hygiene, toileting, transferring, bed
mobility, eating and being able to get around the unit. The results were
published online by the Journal of the American Geriatrics Society and
will appear in a future print issue.
The two most common medical conditions among
nursing home residents are dementia and urinary incontinence and they
often coexist.
The study involved 395 nursing home residents in
Indiana who were taking medications for both conditions and 3,141 who
were taking only a dementia medication.
Residents included in the analysis were age 65 and
older and had had at least two consecutive prescriptions for
cholinesterase inhibitors, a family of drugs used to treat dementia.
Examples include donepezil (Aricept), galantamine (Razadyne),
rivastigmine (Exelon), and tacrine (Cognex). These drugs are designed to
increase levels of acetylcholine, a chemical that enhances communication
between nerve cells in the brain.
About 10 percent of the residents were also taking
either oxybutynin or tolterodine, the two most commonly prescribed drugs
for urinary incontinence. These drugs are known as anticholinergic
agents and are designed to block acetylcholine.
“The two drugs are pharmacological opposites, which
led us to hypothesize that the simultaneous treatment of dementia and
incontinence could lead to reduced effectiveness of one or both drugs,”
said Sink, an assistant professor of internal medicine-gerontology.
She said the finding of the more rapid decline
among residents taking both types of drugs represents a significant
public health problem because an estimated 33 percent of people with
dementia also take a drug for incontinence.
“Until now, the clinical dilemma for managing
incontinence and dementia has been largely theoretical. This research
suggests it may lead to worse outcomes, which is the opposite intention
of therapy for dementia.”
The researchers also measured whether the residents
taking both drugs also experienced a decline in mental function, but
there was no difference between the two groups, possibly because the
test was not sensitive enough. Sink said that similar research should be
extended to community-dwelling older adults with dementia and that more
sensitive measures for cognition should be used. Previous studies have
shown that the bladder medications are associated with cognitive decline
and that people with dementia are especially sensitive to this side
effect.
“The results suggest that clinicians should
continue to try non-drug management strategies for incontinence before
beginning therapy with one of these common drugs,” said Sink.
She noted that the study was conducted in 2003 and
2004, before newer incontinence medications were introduced that may
have less effect on acetylcholine in the brain.
Editor's Notes:
The research was funded by the Hartford Geriatrics
Health Outcomes program, the Kulynych Center for Cognition Research, and
the Regenstrief Foundation.
Co-researchers were Steven Kirtchevsky, Ph.D., with
Wake Forest, and Joseph Thomas, Ph.D., Huiping Xu, Ph.D., Bruce Craig,
Ph.D., and Laura Sands, Ph.D., all with Purdue University.
Wake Forest University Baptist Medical Center (www.wfubmc.edu)
is an academic health system comprised of North Carolina Baptist
Hospital, Brenner Children’s Hospital, Wake Forest University
Physicians, and Wake Forest University Health Sciences, which operates
the university’s School of Medicine and Piedmont Triad Research Park.
The system comprises 1,154 acute care, rehabilitation and long-term care
beds and has been ranked as one of “America’s Best Hospitals” by U.S.
News & World Report since 1993. Wake Forest Baptist is ranked 32nd in
the nation by America’s Top Doctors for the number of its doctors
considered best by their peers. The institution ranks in the top third
in funding by the National Institutes of Health and fourth in the
Southeast in revenues from its licensed intellectual property.
