b'Medicine & ResearchRX UpdateCognitive Impairment When medications are the problemBy Ellen Whipple, Pharm.D.Cognitiveimpairmentisacommon cansometimesimprovethesymptomsofproblem associated with multiple sclerosis, cognitiveimpairment.Additionalfactorsand affects the ability to think, reason, that may exacerbate cognitive impairmentconcentrate, or remember. An estimated 40- include overexertion and heat.70 percent of all persons with MS suer from Anticholinergic medicationsperhaps thesomedegreeofcognitiveimpairment. most common cause of cognitive impairmentTypically,cognitiveimpairmentismore Anticholinergic medications are one of thecommoninpatientswithaprogressive most common causes of acute and chronicdisease course, compared to patients with cognitive impairment in patients both withrelapsing-remitting one (50-60 percent vs. and without MS. Anticholinergic medications35-45 percent, respectively). According to are a class of drugs that block the action ofDr. Ben Thrower, medical director of the MSInstitute at the Shepherd Center, cognitive the neurotransmitter acetylcholine in the brain.impairment can also be observed in patients They are used to treat many diseases includingwith both clinically isolated syndrome and asthma, incontinence, gastrointestinal cramps,radiographically isolated syndrome, and up muscular spasms, depression, and sleepto20percentofpatientswithbenign disorders. multiplesclerosisexperiencecognitive Anticholinergic medications frequently causeimpairment.confusion, memory loss, worsening of mentalCognitive impairment tends to be more function, and other cognitive eects. Elderlysevere in those who have had MS for a longer patients are generally more susceptible to thetime and those with signs of permanent cognitive adverse effects of anticholinergicneurological damage. Cognitive impairment medications compared to younger adults. is not absent, however, from patients with early Examples of anticholinergic medicationsdisease. Because there are many factors that include:may cause or exacerbate cognitive impairmentTrihexyphenidyl (Artane)in MS patients, there are currently no FDA-Benztropine mesylate (Cogentin)approved products to treat MS-related cognitiveimpairment.Flavoxate (Urispas)According to Dr. Thrower, medications areOxybutynin (Ditropan, Oxytrol)sometimestheoffendingagentandcanScopolamineworsen cognitive impairment. Dr. ThrowerHyoscyamine (Levsinex)explained, changing medication regimensTolterodine (Detrol)msfocusmagazine.org 60'