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Q Does my anticholinergic medication increase my risk of dementia?

Q Does my anticholinergic medication increase my risk of dementia?

A Several studies have found that long-term use of anticholinergic drugs is associated with a significantly higher risk of developing dementia, especially vascular dementia, in people over 80. The most recent study, published in June in JAMA Internal Medicine, provides important new information: Certain classes of anticholinergics pose an especially high risk, including bladder antimuscarinics, antidepressants, antipsychotics, anti-Parkinson's, and antiepileptics.

The study specifically looked at the following medications in each of those classes, as well as many others. Some drugs have multiple brand names, so it's Important to look at the actual drug name, not Just the brand, on your own prescription.

Antidepressants. Amitriptyline (Elavil), clomipramine (Anafranil), dosulepin (Prothiaden), Imipramine (Tofranil), nortriptyline (Pamelor), paroxetine (Paxil), and trimipramine (Surmontil).

Anti-Parkinson's. Orphenadrine (Norflex, Flexon), procyclidine (Kemadrin), and trihexyphenidyl (Artane, Trihexane).

Antiepileptic drugs. Carbamazepine (Carbatrol, Equetro, Tegretol) and oxcarbazepine (Trileptal).

Antipsychotics. Chlorpromazine (Thorazine), clozapine (Clozaril), methotrimeprazine (Nozinan), olanzapine (Zyprexa), perphenazine (Trilafon), pimozide (Orap), quetiapine (Seroquel), thioridazine (Mellaril), and trifluoperazine (Stelazine).

Bladder antimuscarinics. Darifenacin (Enablex), fesoterodine (Toviaz), flavoxate (Urispas), oxybutynin (Ditropan), solifenacin (Vesicare), tolterodine (Detrai), and trospium (Sanctura).

There are many other potentially risky anticholinergic drugs beyond these, but this study noted that antihistamines, gastrointestinal antispasmodics, antimuscarinic bronchodilators, antiarrhythmics, and skeletal muscle relaxants did not significantly elevate the risk of dementia.

The researchers stress that this study does not prove causation, only correlation, and that further research is needed to understand the potential risks of these drugs. In the meantime, some anticholinergics have effective alternatives that you and your doctor may want to try.

Q My friend was just diagnosed with a melanoma that didn't fit the normal profile. How do I know what to look for on my own skin?

A The most common guideline to identify suspicious moles--ADCDE--applies to only one type of the disease, superficial spreading melanoma. These melanomas can often be identified by:


Border irregularity

Color variations

Diameter over 1/4 inch (6 mm), and

Evolution or change in appearance.

But a skin lesion that doesn't meet the ABCDE guidelines may still be a melanoma. Here are some additional things to look for:

* Moles or lesi ons that are larger, smaller, darker or redder than other moles or lesions on your body should be regarded as suspicious, as should a mole that is the only one on a part of the body.

* Moles or lesions that are elevated, firm, and progressively growing for a month.

* Any lesions or moles that contain blue or black and that stand out from nearby moles should be regarded with suspicion.

* Some melanomas have no color at all. Amelanotic melanomas lack some or all pigment and can be extremely difficult to identify.

The single most important thing to look for is changes in any skin lesions or the appearance of new ones--whether or not they fit any of these descriptors. You should do your own skin check once per month to look for any warning signs. If you see anything out of the ordinary, play it safe and see a dermatologist.

Because some melanomas--especially those that are amelanotic--are difficult to identify, you should also see a dermatologist once every year for a professional skin check. People at high risk for skin cancer, such as those with freckles, light skin, or high sun exposure, should see the doctor every six months.
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Publication:Duke Medicine Health News
Date:Sep 1, 2019
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