In dementia, which drug classes should be avoided to minimize adverse effects?

• A. SSRIs, beta-blockers, acetaminophen
• B. Antiemetics, laxatives, and diuretics
• C. Anticholinergics, opiates, and benzodiazepines
• D. Digoxin, antibiotics, corticosteroids

Answer: (C)

Medications that impair cognition or provoke delirium are particularly harmful in dementia. Anticholinergic drugs blunt acetylcholine signaling essential for memory and attention, and in someone with dementia this can markedly worsen confusion, disorientation, and delirium. Opiates add central nervous system depressant effects that slow thinking, dull alertness, and increase the risk of delirium and falls. Benzodiazepines carry similar drawbacks—sedation, memory impairment, delirium, and falls—which makes them especially risky for aging patients with cognitive decline. Because these effects can accelerate functional decline and complicate care, they’re best avoided in dementia. Safer approaches focus on nonpharmacologic strategies for behavior and sleep, with alternatives that have lower cognitive risk, such as acetaminophen for pain and cautious use of other medications only when clearly indicated and closely monitored.