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warfarin usage and memory loss

The link between afib and Alzheimer's disease, the most common form of dementia, has been known for a few years, says T. Jared Bunch, MD, Everyday Health columnist, cardiologist at Intermountain Heart Institute, and Medical Director for Cardiac Electrophysiology at Intermountain Health Care in the Salt Lake City area.

Next, Bunch's team looked to see if there was any link between two things — how often these patients with atrial fibrillation had their warfarin within the ideal target range, and whether or not they developed dementia. He used the standard ideal target range, an INR (international normalized ratio) of 2 to 3.

Better Target Range, Less Dementia Risk

Bunch can't yet say if the findings about dementia protection apply to the newer generation anticoagulants, the alternatives to warfarin. His team only studied warfarin.

"The study doesn't suggest we need more blood thinning," Bunch says, "but that we need more effective blood thinning."

"The novel agents do not require frequent monitoring," Bunch says. "There is not a blood test that is commercially available that measures their effectiveness in the blood." He typically monitors kidney function with a blood test twice a year in his patients taking these newer drugs. "We do this because the drug elimination is greatly influenced by changes in kidney function, and if we see a decline, we lower the dose."

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“This [study] highlights the important role of atrial fibrillation and dementia risk and that management strategies of the rhythm itself may also be used to lower dementia rates,” says Bunch.


Bunch adds that because the risks associated with anticoagulants are still not fully understood, only patients that absolutely need them should be placed on them long term.

The same research team previously found a link between warfarin management and dementia risk in patients with AF, but they say the most recent study is the first to show the association in warfarin-treated patients regardless of indication.

James Pickett, head of research at Alzheimer’s Society, says that, given that AF is more common as people get older, it’s important that any links with the risk of dementia are fully investigated. “We know that atrial fibrillation can increase the risk of having a stroke by up to five times if left untreated,” he says. “Given that having a stroke is also a risk factor for developing dementia, it isn’t surprising to see that people with this condition are more likely to develop dementia.

Alternatives: As a first step, it’s important to make sure that you have been properly diagnosed. Check with your doctor or other health professional to see if your urinary incontinence symptoms might stem from another condition (such as a bladder infection or another form of incontinence) or a medication (such as a blood pressure drug, diuretic or muscle relaxant).

How they can cause memory loss: Although these are molecularly distinct from benzodiazepines (see No. 1 above), they act on many of the same brain pathways and chemical messengers, producing similar side effects and problems with addiction and withdrawal.

Why they are prescribed: Beta-blockers slow the heart rate and lower blood pressure and typically are prescribed for high blood pressure, congestive heart failure and abnormal heart rhythms. They’re also used to treat chest pain (angina), migraines, tremors and, in eyedrop form, certain types of glaucoma.

8. Sleeping aids (Nonbenzodiazepine sedative-hypnotics)

Examples: Atorvastatin (Lipitor), fluvastatin (Lescol), lovastatin (Mevacor), pravastatin (Pravachol), rosuvastatin (Crestor) and simvastatin (Zocor).

Examples: Eszopiclone (Lunesta), zaleplon (Sonata) and zolpidem (Ambien).

If you take one of these meds for insomnia, mild anxiety or agitation, talk with your doctor or other health care professional about treating your condition with other types of drugs or nondrug treatments. If you have insomnia, for instance, melatonin might help. Taken before bedtime in doses from 3 to 10 mg, melatonin can help to reestablish healthy sleep patterns.

Examples: Brompheniramine (Dimetane), carbinoxamine (Clistin), chlorpheniramine (Chlor-Trimeton), clemastine (Tavist), diphenhydramine (Benadryl) and hydroxyzine (Vistaril).