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Be cautious about medication side effects that may pose particular problems for elderly patients and those with dementia.

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  • Anticholinergic side effects (e.g., from antipsychotics, antidepressants, diphenhydramine) are problematic in individuals with dementia and can also exacerbate coexisting cardiovascular disease, prostate or bladder disease, or other general medical conditions. Anticholinergic medications may also lead to worsening cognitive impairment, confusion, or even delirium.

  • Elderly patients, especially if suffering from dementia, are more prone to falls and associated injuries because of orthostasis.

  • Medications associated with central nervous system (CNS) sedation (e.g., benzodiazepines) may worsen cognition, increase the risk of falls, and put patients with sleep apnea at risk of additional respiratory depression.

  • Use of antipsychotics may be associated with worsening cognitive impairment, oversedation, falls, tardive dyskinesia, and neuroleptic malignant syndrome, as well as with hyperlipidemia, weight gain, diabetes mellitus, cerebrovascular accidents, and death. The elderly, particularly those with Parkinson's disease or dementia with Lewy bodies, are especially sensitive to extrapyramidal side effects.

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