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BRAIN HEALTH: 

Medications’ Effects on 

Older Adults’ Brain Function

This brochure discusses medications’ cognitive side effects. Understanding potential 

problems that some medications cause can help older adults, families, and Aging Network 

staff to better recognize and manage these side effects. This brochure explains which 

medications affect brain function and why. It also provides links to free resources and tools.

Medications and combinations of medicines can have side effects. Side effects are the unplanned 

symptoms or feelings a person has when taking a drug. Many side effects are not serious and either 

go away on their own or can be easily managed. However, some side effects can cause serious 

health problems, including effects on an older adult’s cognition. Cognition is a person’s ability to think, 

understand, learn, plan, and remember. Cognitive side effects include problems concentrating or 

paying attention, confusion, memory loss, and hallucinations or delusions. Older adults, their families, 

and Aging Network staff that serve them sometimes mistake these side effects for dementia, such as 

Alzheimer’s disease. 

WHAT HAPPENS AS PEOPLE AGE?

As people age, their bodies change in ways that 

can influence how medications affect them. For 

example, older adults’ brains begin to change 

in structure and ability. In addition, changes in 

older adults’ digestive and circulatory systems, 

kidneys, and livers affect how fast medications 

enter and leave their bodies. Weight changes may 

also affect how much medication older adults 

need, and how long drugs stay in their bodies. 

As a result of these normal changes, reactions to 

medications can change as well. 

Chronic health conditions can further complicate 

the effects of medications. Eighty percent of older 

adults have at least one chronic health condition, 

and half have at least two. These health 

conditions can require medications that may 

interact with one another in harmful ways. An 

interaction occurs when one medication affects 

how another works when a person takes the two 

drugs together. In addition, medications can cause 

problems by interacting with food, supplements, 

natural products, 

alcohol, or other 

health conditions. 

For example, when 

mixed with some 

drugs, alcohol can 

cause dizziness, 

drowsiness, 

or changes in 

heartbeat. 

CHRONIC HEALTH 

CONDITIONS CAN 

COMPLICATE THE EFFECTS 

OF MEDICATIONS. 

80% 

OF OLDER ADULTS 

HAVE AT LEAST ONE.
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WHAT GROUPS OF MEDICATIONS MIGHT CAUSE TROUBLE 

WITH COGNITION?

In 2015, the National Academy of Medicine published a report on 

cognitive aging. This report describes some groups of medications 

that may affect older adults’ cognition. These groups include certain 

antihistamines, anti-anxiety and antidepressant medications, sleep 

aids, antipsychotics, muscle relaxants, antimuscarinics for urinary 

incontinence, and antispasmodics for relief of cramps or spasms of 

the stomach, intestines, and bladder. Some of the drugs that can 

cause cognitive problems in older adults are sold over the counter. 

A summary of the Institute of Medicine report is available at http://

iom.nationalacademies.org/~/media/Files/Report%20Files/2015/

Cognitive_aging/Action%20Guide%20for%20Health%20Care%20

Providers_V6.pdf. Chapter 4B of the report contains more detailed 

information on medications and cognitive aging at http://books.nap.

edu/openbook.php?record_id=21693&page=149. 

WHAT DO DOCTORS HAVE TO SAY ABOUT OLDER ADULTS’ 

COGNITION AND USE OF MEDICATIONS?

In 2015, the American Geriatrics Society, whose members are 

doctors, nurses, pharmacists, social workers, and other health care 

professionals serving older adults, updated its list of medications 

that older adults should avoid, or use with caution. The Society’s 

list includes medications that have “anticholinergic” effects. These 

drugs block one of the chemicals (acetylcholine) that brain cells use 

to communicate with each other. A drug’s anticholinergic effects 

can cause older adults to experience confusion, memory loss, and 

worsening of other mental functions, among other things. Several 

research reviews show links between drugs with anticholinergic 

effects and cognitive problems in older adults, such as delirium, 

cognitive impairment, and dementia. 

Older adults should get 

advice from a health care 

professional about use 

of prescription and overthe-counter medications, 

especially before making 

any changes. Health care 

professionals can also 

provide information 

about alternatives to 

medications that may 

harm brain function.
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Some drugs with anticholinergic effects may be 

needed to treat allergies, nausea, depression, 

muscle spasm, and other medical conditions. 

However, sometimes these medications are used 

for the wrong reasons, or as substitutes for other 

medications that are more effective or have 

fewer side effects. Information about alternatives 

is available at http://geriatricscareonline.org/

ProductAbstract/american-geriatrics-societyupdated-beers-criteria-for-potentially-inappropriatemedication-use-in-older-adults/CL001.

Another group of drugs, benzodiazepines, which 

treat anxiety, sleeplessness, and agitation, 

may increase older adults’ risk for memory 

loss, delirium, cognitive impairment, falls, 

fractures, and motor vehicle accidents. The 

American Geriatrics Society says that health 

care professionals need to carefully consider 

these side effects when treating older adults, 

and limit the use of benzodiazepines to treating 

conditions such as seizures or other neurological 

conditions, alcohol withdrawal, severe 

generalized anxiety disorder, and anesthesia, as 

well as end-of-life care.

WHAT SHOULD AGING NETWORK 

STAFF DO? 

Aging Network staff can:

■ Educate older adults, their families, and 

others about the cognitive effects of certain 

types of drugs.

■ Connect people with evidence-based 

resources, and encourage them to discuss 

their medications and any side effects with 

their health care professionals. This is 

especially important during care transitions, 

such as after having surgery or leaving a 

hospital. 

When older adults talk to their health care 

professionals, they or their families need to 

describe any cognitive symptoms they may have, 

and provide a list of their medications, including 

over-the-counter drugs, vitamins, natural products 

and supplements. Talking with their health care 

professionals can help older adults get the best 

and safest treatments possible.

Health care professionals who work in the Aging Network can 

consult the American Geriatrics Society’s 2015 Beers Criteria 

for a list of medications that should be avoided or should be 

used with caution by older adults. If a drug is listed as a 

medication that is potentially inappropriate for, or to be 

avoided in, older adults, this does not mean that the drug is 

unsafe for all of them. Appearing on the list means that these 

drugs may be inappropriate for older adults because of side 

effects, limited effectiveness, or that there are safer treatments 

available. For example, some non-drug treatments such as 

massage or gentle exercise may be appropriate for pain. The 

Society lists many such alternatives on their website.
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American Geriatrics Society 

2015 Beers Criteria

http://geriatricscareonline.org/ProductAbstract/

american-geriatrics-society-updated-beerscriteria-for-potentially-inappropriate-medicationuse-in-older-adults/CL001

Centers for Disease Control and Prevention

Older Adults and Adverse Drug Events

http://www.cdc.gov/MedicationSafety/Adult_

AdverseDrugEvents.html 

Food and Drug Administration

Medicines and You: A Guide for Older Adults

http://www.fda.gov/Drugs/ResourcesForYou/

ucm163959.htm

ADDITIONAL RESOURCES FOR AGING NETWORK STAFF

National Institutes of Health

Talking With Your Older Patient: A Clinician’s 

Handbook

https://www.nia.nih.gov/health/publication/

talking-your-older-patient/foreword

National Institutes of Health

Medicines: Use Them Safely

English: https://www.nia.nih.gov/health/

publication/medicines

Spanish: https://www.nia.nih.gov/espanol/

publicaciones/medicamentos