October 2026 Pharmaceuticals and Your Cognitive Health

Botes Memory Method 

Providing Hope on the Dementia Journey 

MONTHLY NEWSLETTER  |  EDUCATIONAL HANDOUT 

Pharmaceuticals & Your Cognitive Health 

Understanding the impact - and choosing 
the right medication for you 

Medicines can relieve symptoms, treat disease and protect health. Yet some prescription and over-the-counter products can also affect cognition: our ability to pay attention, think clearly, learn and remember. New forgetfulness or unusual sleepiness is not automatically "just aging" or worsening dementia. A medicine, a dose change or an interaction may be contributing.1,2 

The goal is the right treatment, not fewer medicines at any cost. Do not stop or change prescribed medication on your own. Some medicines require a gradual, supervised reduction.4,11 

Why the same medicine may affect you differently 

As we age, changes in kidney and liver function can make some medicines stay in the body longer. A dose that worked years ago may affect you differently today. Taking several medicines also creates more opportunities for interactions. Include nonprescription medicines, supplements and alcohol in the conversation with your healthcare team.2 

Medicines that deserve a closer look 

Anticholinergic medicines. These block acetylcholine, a chemical that helps brain cells communicate. Examples include diphenhydramine and doxylamine in some allergy or nighttime products; oxybutynin for an overactive bladder; and amitriptyline, an antidepressant also used for other conditions. They can cause confusion and memory problems. Taking several together adds to the anticholinergic burden, or their combined effects.1,3 

Sedating medicines. Anxiety medicines such as lorazepam or alprazolam, and sleeping pills such as zolpidem, can impair alertness and increase confusion and fall risk in older adults. Opioid pain medicines and some muscle relaxants can also cause drowsiness. Combining sedating medicines, or mixing them with alcohol, can be dangerous.2-4 

Antipsychotic medicines. Sometimes prescribed for hallucinations or severe agitation, these require special caution in dementia because of stroke and death risks. Brexpiprazole (Rexulti) is approved for agitation associated with Alzheimer's dementia, but still carries serious warnings. Ask about the target symptom, non-drug approaches and a plan to reassess benefit and safety.3,5 

These are examples for review, not a list of medicines everyone must stop. The reason for treatment and the individual person matter.3 

Does taking a medicine mean it causes dementia? 

Not necessarily. A large 2019 study in JAMA Internal Medicine linked substantial exposure to certain strong anticholinergic drugs with dementia. However, observational studies cannot establish cause and effect. A 2025 BMJ Medicine study of bladder medicines found higher dementia risk compared with non-users, but not compared with people using another bladder treatment. These findings support careful review, not panic or abrupt stopping 6.7 

CHOOSING TREATMENT WITH YOUR HEALTHCARE TEAM 

Medicines can also support brain health 

A 2025 follow-up of the NIH-supported SPRINT trial found that more intensive blood-pressure treatment reduced the combined outcome of mild cognitive impairment or probable dementia in selected adults with hypertension. It did not establish a clear reduction in dementia alone. Your blood pressure goal should be individualized, not copied from a study.8 

Alzheimer's treatments have different purposes. Medicines such as donepezil, rivastigmine, galantamine and memantine may help manage symptoms, depending on the disease stage. Lecanemab and donanemab can slow decline in eligible people with early Alzheimer's and confirmed buildup of amyloid protein. They do not cure the disease or restore lost memory and require specialist assessment and regular MRI brain scans because brain swelling or bleeding can occur.9,10 

Five questions to help choose the right treatment 

1. What are we treating, and what benefit should I notice? Agree on a goal, such as less pain, improved sleep or better daily function. Ask how long it should take to see a benefit.2,11 
2. Is there a lower-risk option? Ask about a medicine with less cognitive impact or a non-drug approach. For ongoing insomnia, cognitive behavioral therapy for insomnia (CBT-I) is an evidence-based treatment that teaches skills to improve sleep.1,12 
3. Does it fit my health and everything else I take? Ask whether the dose fits your kidney and liver function. Review allergies, past side effects, interactions and duplicate ingredients. Bring all prescriptions, over-the-counter products, vitamins and supplements, including occasional sleep aids.2,3,11 
4. Can I use it safely and reliably? Discuss cost, timing, swallowing difficulties and help with taking medicines. Ask before crushing tablets or opening capsules. A trusted care partner may help with a safe routine.11 
5. When will we review whether it is still needed? Ask what side effects to watch for and when to follow up. Deprescribing means carefully reducing or stopping unnecessary or potentially harmful medicines with clinical supervision, not stopping treatment yourself.11 

Notice changes in everyday life 

Keep a brief record of new sleepiness, confusion, unsteadiness or changes in daily activities, and note when medicines or doses change. A care partner might say, "Since this medicine was started, she sleeps through meals and needs more help dressing." Specific observations help the healthcare team evaluate the treatment.2,11 

Sudden confusion needs urgent medical attention. A change over hours or days may be delirium caused by illness, dehydration, medicine or withdrawal, rather than dementia progressing. Call 911 for sudden unexplained confusion, trouble breathing, a seizure or inability to wake normally.4,13 

Your next step: Bring your complete medication list to your next appointment and ask, "Could any of these medicines be affecting my thinking, and is this still the best plan for me?"1,11 

At Botes Memory Method, our focus is the whole person: comfort, participation, dignity and meaningful connection. 

RESEARCH & TRUSTED RESOURCES 

The evidence behind this article 

Peer-reviewed studies, professional guidance and U.S. health-agency resources. Reference numbers correspond to the article. Links are active in the digital version. 

1.  National Institute on Aging. Brain Health: Medicine, Age, and Your Brain. NIH educational fact sheet. NIA resource 
2.  U.S. Food and Drug Administration. As You Age: You and Your Medicines. FDA guidance 
3.  American Geriatrics Society Beers Criteria Update Expert Panel. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71:2052-2081. doi:10.1111/jgs.18372. Full text 
4.  U.S. Food and Drug Administration. Benzodiazepine Drug Class: Drug Safety Communication - Boxed Warning Updated to Improve Safe Use. 2020. FDA safety communication 
5.  U.S. Food and Drug Administration. Rexulti (brexpiprazole) prescribing information. Revised April 2026. Boxed warning and sections 1 and 5. FDA label 
6.  Coupland CAC, et al. Anticholinergic drug exposure and the risk of dementia: a nested case-control study. JAMA Intern Med. 2019;179:1084-1093. doi:10.1001/jamainternmed.2019.0677. PubMed 
7.  Pourhadi N, et al. Bladder drugs and risk of dementia: Danish nationwide active comparator study. BMJ Medicine. 2025;4:e001125. doi:10.1136/bmjmed-2024-001125. Full text 
8.  Reboussin DM, et al. Long-term effect of intensive vs standard blood pressure control on mild cognitive impairment and probable dementia in SPRINT. Neurology. 2025;104:e213334. doi:10.1212/WNL.0000000000213334. PubMed 
9.  National Institute on Aging. How Is Alzheimer's Disease Treated? NIA resource 
10.  U.S. Food and Drug Administration. Earlier MRI monitoring for patients taking Leqembi (lecanemab), August 28, 2025; FDA approves treatment for adults with Alzheimer's disease (Kisunla), July 2, 2024. Leqembi safety | Kisunla evidence 
11.  National Institute on Aging. Taking Medicines Safely as You Age. NIA resource 
12.  Edinger JD, et al. Behavioral and psychological treatments for chronic insomnia disorder in adults: an American Academy of Sleep Medicine clinical practice guideline. J Clin Sleep Med. 2021;17:255-262. doi:10.5664/jcsm.8986. PubMed 
13.  National Library of Medicine, MedlinePlus. Delirium; Confusion. Delirium | Confusion 

Educational information only. This article does not diagnose a condition or replace individualized advice from a qualified prescriber or pharmacist. Do not start, stop or change medicines based on this handout alone. 

Sources checked September 28, 2026. Prepared for Botes Memory Method.