Dangerous mix of medication leads to faulty Alzheimer's diagnosis
by Rosa Marchitelli for CBC:
Three years ago, Betty Wallwork was taking a long list of drugs. Some to help her heal from a cataract operation, another to ease the pain of an earache, and others to treat a swollen ankle and help get rid of a lingering chest cold.
She's now warning others about what could happen when the wrong medications are mixed, after she was diagnosed with Alzheimer's.
"I was losing my temper, walking around the house in a daze. I was saying stupid things, I was having arguments with people. I was so sick I didn't know I was sick," the now 85-year-old Ontario woman told Go Public.
Experts say the wrong mix of drugs can cause unexpected cognitive side-effects in seniors, including confusion, memory loss and aggression: symptoms that may be misdiagnosed as Alzheimer's disease.
In Wallwork's case, she took her concerns to her family doctor. "I said to the doctor, 'It sounds like Niagara Falls in my head.'"
But instead of looking at her medications, Wallwork's doctor gave her an Alzheimer's test. When she failed it, her driver's licence was taken away.
Wallwork says she left the doctor's office angry, confused and in tears. Then she took matters into her own hands.
"I decided to prove there's nothing wrong with me. I looked up every drug I had ever taken," she says.
After spending hours online reading up on drug reactions, Wallwork realized her mix of medications wasn't improving her health, but making it worse.
"It wasn't until I stopped taking all these medicines that I looked back and thought, 'Oh! Did I really say that or really do that?'... I was not myself."
Wrong mix of medications causes dementia
Larry Chambers, a scientific adviser with the Alzheimer Society of Canada, isn't surprised to hear what happened to Wallwork.
Chambers says up to 20 per cent of dementias could be due to a bad mix of medications.
Some of the anticholinergics and antihistamines are very dangerous for cognitive impairment. The other really big one is benzodiazepine that is used for helping people sleep," he says.
It's not just prescription medications that can lead to cognitive issues — over-the-counter ones can too.
"Three really big ones are omega 3 fish oil, Aspirin, and garlic," Chambers says.
"These are known to be contraindicated and cause problems with cognitive functioning and lead to dementia if taken with some heart medications that a physician might prescribe."
In these cases, says Chambers, the dementia can be reversed once the medication is stopped or adjusted.
That's why he encourages seniors and their families to track all prescription and nonprescription drugs and share that information with their doctor and pharmacist.
Canada's polypharmacy problem
Chambers says the risk of the elderly developing dementia after taking the wrong mix of medications is increasing as more seniors are being prescribed more drugs.
It's called polypharmacy, the use of a large number of medications — commonly five or more — usually involving someone over the age of 65.
Chambers says people over 65 represent about 13 per cent of the population, but they take about 40 per cent of all drugs in the country.
"It's really easy for the health-care system to prescribe and prescribe and there aren't enough checks and balances in the system to avoid problems," says Chambers.
"The big issue with these drugs is you have to take people off them if they are going to be able to live a normal life."
Chambers also urges seniors to talk to their doctor before making any changes to their medication.
Patchwork of provincial programs
Most provinces have drug monitoring systems that warn pharmacists about possible drug reactions, but it's up to individual provinces to decide how those systems work.
In most provinces, the participation of doctors and pharmacists in those programs is voluntary, and monitoring systems may cover the entire population — as is the case in British Columbia and Prince Edward Island — or only certain segments of the population.
Some programs only track certain types of drugs, such as narcotics, that are at risk for addiction or street resale.
Another issue is that records are often not shared between pharmacies, so if prescriptions are filled at different locations, no alert is issued.
In Ontario, where Betty Wallwork lives, the province does monitor medications for certain groups. Those include people whose medications are covered by provincial drug benefit programs.
But according to Ontario Health, the information collected is used to track the amount and types of drugs dispensed in that province, not to flag adverse reactions.
Monitoring systems
The Canadian Pharmacists Association wants provinces to upgrade their monitoring systems to give pharmacists and hospitals "access to the patient's complete medication record."
That kind of system would track prescription, nonprescription and natural health products.
"However, governments need to invest in the tools required to ensure better information and enhanced safety," says Mark McCondach, director of communications with the Canadian Pharmacists Association.
In 2001, the federal government created Canada Health Infoway, with the mandate to help accelerate the adoption of digital health records. The organization's been pushing for electronic records that would track prescriptions paperlessly.
The Liberal government set aside $40 million in this year's budget to push that forward.
"If you can see all of the other medications that individual has been prescribed, then you empower the prescriber to do some front-line monitoring, for example," Lynne Zucker from Canada Health Infoway told Go Public.
Senior gets own cognitive test
After stopping her medication, Betty Wallwork had new cognitive tests done, which showed none of the concerning signs her doctor noted in her previous test.
Then she took a driver's test and got her licence back. Wallwork says the medical system needs to do a better job of warning patients and their families about problems that arise from the wrong mix of medication.
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