Medications for anxiety, insomnia, bladder problems, allergies, or behavioral symptoms may seem unrelated. But for an older adult living with dementia or mild cognitive impairment, some of these drugs share an important problem: they can worsen confusion, increase the risk of falls, or cause other side effects that become particularly concerning when cognition is already impaired.
A 2026 study published in the Journal of the American Geriatrics Society suggests these prescriptions remain surprisingly common.
Researchers from the University at Buffalo examined medication use among 2,796 adults aged 65 and older with dementia or mild cognitive impairment who were living in the community. The good news was that exposure to medications considered potentially inappropriate for people with cognitive impairment fell substantially between 2011 and 2022.
The concerning part was how common they remained.
In 2022, nearly 3 in 10 older adults with cognitive impairment were still exposed to at least one of these medications. The list includes familiar drug classes such as benzodiazepines, certain sleep medications, anticholinergic drugs, and antipsychotics.
That doesn’t mean everyone taking one of these medications should stop. In some circumstances, the benefits may outweigh the risks. Instead, the findings highlight something much more practical: as people age and their health changes, medications that once made sense may deserve another look.
Which Drugs Are Flagged – and Why They’re Risky for This Population
Older adults with cognitive disorders, including dementia and mild cognitive impairment, are particularly vulnerable to adverse effects from centrally acting medications. The drugs of concern include anticholinergics, antipsychotics, benzodiazepines, and non-benzodiazepine hypnotics (Z-drugs). Each carries its own risk profile, and those risks sharpen when a person’s brain is already under strain from cognitive disease.
The American Geriatrics Society Beers Criteria is a regularly updated list of medications considered potentially harmful to limit or avoid in older adults, and it served as the framework for the University at Buffalo study. Physicians and pharmacists use it as a practical screening tool when reviewing older patients’ prescriptions.
Benzodiazepines – medications like diazepam and lorazepam, commonly prescribed for anxiety and insomnia – represent one of the clearest risks. They can impair balance, coordination, and cognition in older adults. A 2022 study published in the Journals of Gerontology found that benzodiazepines consistently induced both memory-related and other forms of cognitive impairment, with larger effects among participants aged 65 and older. Exposure to potentially inappropriate medications has also been associated with higher rates of emergency department visits and hospitalizations.
Z-drugs – including zolpidem and eszopiclone, marketed as sleep aids – carry comparable dangers for older adults with dementia, similar in nature to those posed by benzodiazepines. Antipsychotics present a different but equally serious concern: the FDA has issued a black-box warning on all antipsychotic medications due to increased mortality risk in elderly patients with dementia. Despite that warning, a meaningful share of dementia patients continue to receive them.
The Anticholinergic Problem Runs Deeper Than Most Patients Know
Anticholinergics are a broad class of medications that block acetylcholine – a brain chemical central to memory and learning. This class includes some antihistamines, bladder medications, certain antidepressants, and drugs prescribed for overactive bladder. Many people take them without knowing their long-term cognitive implications.
The evidence on cumulative exposure has grown more concerning. A 2025 analysis found that anticholinergic use for three months or more was associated with an estimated 46% increase in dementia risk on average. A 2020 study published in Age and Ageing confirmed that anticholinergic medications are associated with increased risk of cognitive decline in older adults – a finding that applies even to people who have not yet received a dementia diagnosis.
For someone already living with a cognitive disorder, the use of multiple anticholinergic drugs together compounds these risks further. Each additional anticholinergic drug in a patient’s regimen raises exposure to a chemical mechanism that directly undermines the brain processes already compromised by cognitive disease.
Polypharmacy: When the Problem Is the Combination, Not Just the Drug
Taking many medications simultaneously – polypharmacy – is common among older adults managing multiple chronic conditions. When several centrally acting drugs are combined, their individual risks don’t simply add up; they interact in ways that can produce effects more severe than any single drug would cause alone.
The University at Buffalo research highlighted this dimension specifically. Researchers focused on medications that act on the brain and nervous system, noting that risk escalates when several are taken together. Exposure to potentially inappropriate medications was associated with higher odds of poor mental quality of life and increased rates of emergency department visits and hospitalizations.
For families navigating these dynamics, a related piece on medications linked to dementia and memory loss offers useful background on which drug classes are most commonly flagged and why.
What Deprescribing Actually Means – and Who Should Lead It
Deprescribing is the deliberate, supervised process of reducing or stopping medications that are no longer appropriate. It has emerged as a clinical practice to reduce polypharmacy and use of potentially inappropriate medications. Some medications, particularly benzodiazepines, can cause serious withdrawal effects if discontinued abruptly, which is why any changes need to be managed carefully by a health professional.
Pharmacists are increasingly central to making this happen. Their view of a patient’s full medication list positions them to spot dangerous combinations or drugs whose original purpose no longer applies – something that any single prescribing physician may not have visibility into. Doctors, pharmacists, nurses, patients, and families can work together to review medications and decide whether changes are needed.
The University at Buffalo study noted that many of the older adults in their sample had regular health care contact – meaning the opportunities for medication review already existed. The gap was not access to doctors, but whether those visits included a systematic look at whether every drug on the list still belonged there.
What to Do Now
A ten-point drop in inappropriate medication exposure over eleven years – from 39.3% to 29.3% – reflects real improvements in prescribing awareness. Nearly a third of older adults with cognitive disorders were still exposed to these drugs as recently as 2022, which indicates the work is far from finished.
If you have a parent, partner, or patient over 65 with dementia or mild cognitive impairment, the most concrete step is a full medication review – ideally with a pharmacist or a physician who has time to go through the list drug by drug. Ask specifically whether any medication appears on the Beers Criteria, how long it has been prescribed, what it was originally prescribed for, and whether that reason still applies. Medications started during a hospital stay are worth particular scrutiny, since prescriptions initiated in acute settings do not always get reassessed once a patient is home and stable.
For sleep problems and anxiety – two of the most common reasons benzodiazepines and Z-drugs get prescribed – non-pharmacological alternatives exist with growing evidence behind them: cognitive behavioral therapy for insomnia, structured activity programs, and environmental modifications all have research support without the cognitive risks. The goal is not necessarily no medication; it is making sure every medication still has a reason to be there.
Disclaimer: The author is not a licensed medical professional. The information provided is for general informational and educational purposes only and is based on research from publicly available, reputable sources. It is not intended to constitute, and should not be relied upon as, medical advice, diagnosis, or treatment. Always consult a licensed physician or other qualified healthcare provider regarding any medical condition, symptoms, or medications. Do not disregard, avoid, or delay seeking professional medical advice or treatment because of information contained herein.
AI Disclaimer: This article was created with the assistance of AI tools and reviewed by a human editor.
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