Some medications that seem routine for older adults can quietly create serious problems when someone is living with dementia or mild cognitive impairment. Drugs for anxiety, insomnia, overactive bladder, allergies, or behavioral symptoms might appear unrelated, yet many share a crucial issue: they can worsen confusion, increase the risk of falls, and trigger other side effects that become especially dangerous when cognition is already fragile. Concerns about benzodiazepines, anticholinergic medications, and other potentially inappropriate drugs have grown as researchers look more closely at dementia risk and medication exposure in older adults.

A 2026 study published in the Journal of the American Geriatrics Society examined medication use among 2,796 adults aged 65 and older who had dementia or mild cognitive impairment and were living in the community. The findings carried both hopeful and sobering messages. On the positive side, exposure to medications considered risky for people with cognitive impairment dropped substantially between 2011 and 2022. That reflects growing awareness among clinicians about safer prescribing practices for older adults with memory problems. At the same time, the study revealed that these medications are still widely used. Nearly three in ten older adults in the study were exposed to at least one such drug in 2022, despite well documented risks.

Doctors and pharmacists often turn to the American Geriatrics Society Beers Criteria when reviewing medication lists for older adults. The Beers Criteria is a regularly updated guide that identifies drugs which may be inappropriate or harmful for older patients, especially those with cognitive disorders. In the University at Buffalo study, researchers used this framework to identify the classes of drugs of particular concern: benzodiazepines, non-benzodiazepine hypnotics (sometimes called Z-drugs), anticholinergic medications, and antipsychotics. Each of these affects the brain and nervous system in ways that can magnify confusion, impair thinking, and undermine safety for someone already dealing with dementia.

Benzodiazepines are among the most recognizable names on that list. Medications such as diazepam and lorazepam are frequently prescribed for anxiety or insomnia. In younger people and in short-term use, they may appear to offer quick relief. For older adults, especially those with dementia, the balance shifts. These drugs can impair balance and coordination, slow reaction times, and cloud memory. A 2022 study in the Journals of Gerontology found that benzodiazepines consistently caused memory-related and other forms of cognitive impairment, with larger effects in adults over 65. For someone who is already forgetting details or struggling to stay oriented, an added layer of medication-induced confusion can have profound consequences.

Z-drugs such as zolpidem and eszopiclone are often marketed as sleep aids that differ from benzodiazepines. Yet research suggests that for older adults with dementia, the risks look similar. These medications can lead to nighttime confusion, increased falls, and daytime grogginess, all of which can worsen quality of life. Antipsychotic medications present a different kind of concern. While they may sometimes be prescribed for severe behavioral symptoms in dementia, they carry a black-box warning from the FDA because they are associated with increased mortality in elderly patients with dementia. Despite this warning, a meaningful share of people with dementia continue to receive antipsychotics, often for behavioral issues that might be approached first with environmental changes or non-drug strategies.

Among all these medication categories, anticholinergic drugs are perhaps the least recognized by patients and families, yet their impact can be far reaching. Anticholinergics work by blocking acetylcholine, a brain chemical that is central to memory and learning. This group includes some antihistamines, bladder medications, certain antidepressants, and drugs used for overactive bladder. Many people use them for months or years without realizing that they may be affecting long-term brain health. Emerging research has become more concerning over time. A 2025 analysis found that anticholinergic use for three months or more was associated with an estimated 46 percent increase in dementia risk on average. A 2020 study in the journal Age and Ageing also linked anticholinergic medications to a higher risk of cognitive decline in older adults, including those who did not yet have a dementia diagnosis.

For someone already living with a cognitive disorder, these risks can compound quickly. Taking multiple anticholinergic drugs together increases cumulative exposure to a mechanism that directly interferes with memory and learning. Each additional anticholinergic medication adds to the burden on brain systems that are already struggling. When this occurs in the context of polypharmacy, the picture becomes even more complex. Polypharmacy, or the use of many medications at once, is common among older adults who manage several chronic conditions. The University at Buffalo research emphasized that when several centrally acting drugs are combined, their risks do not merely add up. Instead, they can interact in ways that intensify side effects, increase confusion, and raise the likelihood of emergency visits or hospitalizations.

I found it striking that in the study, many older adults with dementia or mild cognitive impairment were already seeing health professionals regularly. The issue was not a lack of medical contact. Instead, the gap lay in whether those visits included a careful review of each medication to determine if it was still needed and appropriate. This is where deprescribing comes in. Deprescribing is a deliberate, supervised process of reducing or stopping medications that may no longer be beneficial or safe. The goal is not to abandon treatment but to make sure each drug on the list has a clear current purpose, with benefits that outweigh its risks.

Deprescribing needs to be handled thoughtfully, especially with medications like benzodiazepines that can cause significant withdrawal symptoms if stopped abruptly. This is why it should always be guided by a physician, pharmacist, or other qualified healthcare professional. Pharmacists are playing an increasingly central role in this process. Because they often have a complete view of the medications a person is taking, they can identify potentially risky combinations and flag drugs that may have outlived their original purpose. Working together, doctors, pharmacists, nurses, patients, and families can examine the medication list drug by drug and decide whether adjustments are needed.

For families and caregivers, the practical next step is often a comprehensive medication review. For an older adult over 65 with dementia or mild cognitive impairment, that review can be scheduled with a primary care physician, geriatrician, or pharmacist. Questions to ask include whether any medication appears on the Beers Criteria, how long each drug has been taken, what it was originally prescribed for, and whether that reason still applies today. Medications started during a hospital stay deserve particular attention, since drugs initiated in a crisis do not always get re-evaluated once the person returns home and stabilizes.

Sleep problems and anxiety are two of the most common reasons that benzodiazepines and Z-drugs are prescribed, yet they are not the only options. Non-drug approaches such as cognitive behavioral therapy for insomnia, structured daily activity, and environmental adjustments have growing evidence behind them and do not carry the same cognitive risks. For many people, the goal is not to eliminate all medications, but to ensure a safer, more thoughtful balance. The University at Buffalo study showed a ten-point reduction in exposure to potentially inappropriate medications over eleven years, dropping from 39.3 percent to 29.3 percent. That progress is encouraging, yet the fact that nearly one-third of older adults with cognitive disorders were still exposed to these drugs as recently as 2022 shows that there is more work to do.

Bringing medications into the conversation about dementia care can feel overwhelming at first, but it is one of the most concrete ways families and clinicians can improve safety and quality of life. By asking focused questions, reviewing prescriptions regularly, and exploring non-pharmacological alternatives when possible, it becomes easier to align treatment with what matters most for each person living with cognitive impairment. Ultimately, the safest plan is usually the one in which every medication has been reconsidered in light of age, brain health, and current needs, rather than simply carried forward because it has always been there.

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