Polypharmacy in Alzheimer's disease May Cause or Exacerbate Reflux Dysphagia
Pharmacological intervention is necessary and fundamental to the treatment of Alzheimer's disease. Alzheimer's disease is associated with a wide range of comorbidities and each of those diagnoses needs to be addressed in addition to the degenerative neurocognitive pathology.
Trying to combat the cognitive decline associated with Alzheimer's pathology, physicians and/or nurse practitioners may recommend the use of Acetylcholinesterase Inhibitors and NDMA antagonists. Then, a patient may have other cardiovascular, metabolic or renal dysfunction and the patient needs medical intervention for each of those comorbidities. Finally, the neurocognitive degeneration associated with Alzheimer's disease causes other neuropyschiatric impairment which require more neuropharmacological interventions.
It is easy to see how an aging patient ends up with 5 or more medications being prescribed concurrently to address the patient's entire health profile.
The combination of pharmacological interventions can wreak havoc on the swallow and the gut.
The following short list of medications demonstrates the relationship of polypharmacy and reflux dysphagia in medications used to treat dementia:
1. Acetylcholinesterase inhibitors (e.g. Exelon, Razadyne, Aricept, etc.) can cause or exacerbate gastroesophageal reflux disease (GERD) and cause other major adverse drug reactions.
(GI DYSPHAGIA)
2. NMDA antagonists (e.g. Memantine, etc.) may result in difficulty concentrating, agitation, confusion and other issues.
(NEUROCOGNITIVE DYSPHAGIA)
3. Benzodiazepines, commonly used to treat anxiety, mood and seizures, are a major precipitate to GERD and disruption to GI motility.
(GI DYSPHAGIA)
4. Common selective norepinephrine reuptake inhibitors used to treat ADHD can cause nausea, dry mouth, insomnia, thrush, etc.
(GI DYSPHAGIA)
5. Other drugs, such as amphetamines, that are use to treat attention issues can cause and/or exacerbate GERD symptoms. What you may not know is that Clonidine is frequently prescribed alongside the amphetamine to help with sleep, and Clonidine has been directly linked to GERD onset.
(GI DYSPHAGIA)
6. Selective serotonin reuptake inhibitors cause serious GI upset and weight changes.
(GI DYSPHAGIA)
7. Seizures can accompany the dementia pathology and anticonvulsants such as Dilantin, Cerebyx, Valium and Ativan have been shown to not only increase/exacerbate GERD, cause nausea and other GI upset, but it has been directly linked to dysphagia in nearly 1 in 5 individuals
(GI DYSPHAGIA)
Polypharmacy in the aging community is becoming a hot topic, and we are committed to expanding our understanding of the relationship between polypharmacy and issues pertinent to the aging community.
If you would like to know more about the Five Systems of Dysphagia, checkout our website at dysphagiamanagement.com!
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