For some time professional senior caregivers have "known," without much research to back them up, that the drugs we currently use to treat dementia symptoms can have some serious repercussions. Now there is research evidence that draws the same conclusion and adds some new concerns. Not every patient will experience serious side effects from these medications, but enough do that we should seriously explore the potential negtives as well as the positives before giving them to our elders.

Doctors have four primary medications to prescribe for mild to moderate Alzheimer's Disease and some other dementias. In some patients they may delay symptoms for a limited time, and they may help to control some difficult behavioral symptoms for a while. Razadyne® (previously called Reminyl®), Exelon® (rivastigmine), and Aricept® (donepezil) are in the class called "cholinesterase inhibitors." These three medications seem to reduce or delay dementia symptoms in some patients for 6 to 18 months, on average.

The fourth medication in the dementia arsenal, Namenda® (memantine), is in a different medication group and is not part of this discussion.

The three cholinesterase inhibitors presently available are where important questions arise. Every physician and caregiver should seriously weigh the pros and the cons of these medications before deciding whether one or more will be "right" for their particular dementia patient.

Nausea, vomiting and diarrhea have long been recognized as possible side effects of these medications. Many patients do not experience these side effects, and some overcome them within a short period of time. Now the publication of a new study gives us some even more worrisome complications to consider.

The May 11, 2009 issue of the Archives of Internal Medicine published the results of a large study that concludes, "Cholinesterase inhibitors are associated with previously underrecognized serious adverse events in older adults with dementia, which must be carefully balanced against the generally modest benefits of these drugs."

Some of the more serious apparent consequences that cholinesterase inhibitor test subjects experienced were:

1. A statistically significant higher number of subjects using cholinesterase inhibitors made hospital visits for syncope than did control subjects not using these medications:

Syncope: the temporary loss of consciousness due to a sudden decline in blood flow to the brain. It may be caused by an irregular cardiac rate or rhythm or by changes of blood volume or distribution. Syncope can occur in otherwise healthy people. The patient feels faint, dizzy, or lightheaded (presyncope), or loses consciousness (syncope).*

2. A statistically significant higher number of subjects using cholinesterase inhibitors made hospital visits for bradycardia than did control subjects not using these medications:

Bradycardia: slow heartbeat, usually at a rate under 60 beats per minute (normal resting rate is 60 - 100 beats per minute).*

3. A statistically significant higher number of subjects using cholinesterase inhibitors required pacemaker insertion:

Pacemaker: A small device placed under the skin of the chest or abdomen to help control heart rhythms that are too slow, too fast, or irregular.*

4. A Statistically significant number of subjects using cholinesterase inhibitors suffered hip fractures.

While many patients have done well on these medications, and many families have observed a temporary improvement in behavior and functioning, we advise every caregiver to discuss these new findings with their elder's doctor before starting a cholinesterase inhibitor. Seniors who already have low blood pressure, a history of cardiac problems, or are already prone to falls should be especially careful to get all the information they can before starting Razadyne®, Exelon® or Aricept®.

*Definitions courtesy of the National Institutes of Health