As a partner with the Alzheimer’s Foundation of America, I conduct memory screenings for families across the Triad. These aren’t diagnostic tests, but they help us identify changes over time—especially when our Options caregivers notice shifts in cognition during daily visits. We can re-screen and track progression.
But here’s what surprised me: some clients actually improved on follow-up screens. Why?
The answer was usually sitting on their kitchen counter.
At Options, we offer medication reviews as part of our service. Since we’re non-medical home care, we can’t adjust prescriptions—but we can give families the knowledge they need to advocate with their doctors. Sometimes it’s just nice to have someone in your corner who’s spent years in geriatric pharmacy and knows what to look for.
Before we accept a memory screen score at face value, we need to recognize that medications often play a huge role. That’s why I started using what I call “calling the MEDIC”:
- Medication burden
- Errors and duplication
- Dose and dynamics
- Interactions and illness
- Context
Address these factors, and you’ll often recover several points on a re-screen within just a few weeks. I firmly believe that treating a score without first optimizing medications risks premature diagnoses and avoidable harm.
The Bottom Line:
Before you accept a “borderline dementia” diagnosis, look at the medication list. Anticholinergics, sedatives, and duplications can drop memory screen scores by 4-5 points, but they’re potentially fixable. Review medications first (using the MEDIC framework below), optimize with your doctor, then re-test in 4-6 weeks. You might avoid a premature diagnosis and get your loved one back.
So what does it look like to call the MEDIC?
M — Medication Burden
We all know someone taking 15+ medications. But how often do we actually stop and assess what they’re taking
When I review medication lists, I’m looking for dangerous combinations—anticholinergic medications layered with sedatives. I regularly see diphenhydramine (Benadryl) or other over-the-counter sleep aids stacked with muscle relaxers, overactive bladder medications, benzodiazepines, and opioids. Each one alone might be manageable. Together? They’re a cognitive wrecking ball.
The first step is simple: tally the burden and identify which medications might be tapered or substituted.
E — Errors and Duplication
In the senior population, it’s common to see multiple doctors across different pharmacies. While healthcare systems are improving, duplication still slips through.
I’ve seen clients taking two different medications for the same condition without realizing it. PRN (as-needed) medications that have drifted into daily use. Combination drugs with “hidden” ingredients—like Tylenol PM containing both acetaminophen and diphenhydramine—that families don’t recognize as sleep aids.
When you’re managing care for a loved one, bringing all their pill bottles to one appointment can reveal duplications no single provider would catch.
D — Dose and Dynamics
As we age, kidney and liver function change. The medication dose that worked at 60 may be too high at 85.
I see this constantly with blood pressure medications. Tight BP targets that made sense in your 30s can cause hypotension and dizziness when you’re 80+. But instead of questioning the medication, we chalk it up to “getting older” or “walking slower.”
Timing matters, too. If someone takes a sedating medication at night and gets tested the next morning, they’re still experiencing peak sedation during the screen. The score reflects the drug, not their baseline cognition.
I — Interactions and Illness
Our bodies are constantly working to maintain balance. Medications have intended effects—but they also have unintended effects (side effects). Pair that with medications that fight against each other or team up in the wrong ways, and the body can’t keep up.
I also look at what’s happening acutely. Is the person being treated for a UTI with antibiotics? Are they on steroids for inflammation? Even short-term illness and treatment can temporarily tank cognitive performance.
Sometimes what looks like dementia is actually delirium from an untreated infection or a medication interaction.
C — Context
The time and place of the test matter more than most people realize.
Is the older adult dehydrated? Experiencing low blood sugar? Sleep-deprived? Are they wearing their hearing aids and glasses during the test? Did they eat breakfast?
I’ve seen scores improve by 4–5 points simply by re-testing under better conditions: rested, hydrated, after a meal, with sensory aids in place.
Before we label someone with cognitive decline, we need to make sure we’re testing their brain—not their circumstances.
Clinical Note:
When assessing anticholinergic burden, I typically reference the Anticholinergic Cognitive Burden (ACB) scale and cross-check with AGS Beers Criteria. High-burden medications (ACB score 3) include diphenhydramine, oxybutynin, and TCAs. Even moderate-burden drugs (ACB 2) can compound when combined with sedatives.
Common Medications That May Lower Memory Scores:
If your loved one takes 2 or more medications from this list, a medication review is critical:
Anticholinergics:
- Diphenhydramine (Benadryl, Tylenol PM, Advil PM)
- Oxybutynin (Ditropan) or tolterodine (Detrol) for overactive bladder
- First-generation antihistamines like chlorpheniramine and hydroxyzine
- Tricyclic antidepressants like amitriptyline and nortriptyline
Sedatives:
- Benzodiazepines: alprazolam (Xanax), lorazepam (Ativan), diazepam (Valium)
- Sleep medications: zolpidem (Ambien), eszopiclone (Lunesta)
- Muscle relaxers: cyclobenzaprine (Flexeril), methocarbamol (Robaxin)
Other Common Culprits:
- Gabapentin and pregabalin (Lyrica), especially at high doses
- Opioid pain medications, particularly long-acting formulations
- Paroxetine (Paxil), a highly anticholinergic antidepressant
Many of these are available over-the-counter or hidden in combination products. Families often don’t realize “PM” medications contain diphenhydramine—one of the most potent anticholinergics affecting memory.
When “Confused” Was Really Over-Medicated
This client came to us in an unusual situation: he was moving from assisted living back home. Normally, it’s the other way around. But I’ve always believed in keeping people at the lowest level of care possible for as long as possible, then adjusting upward as needs change. Sometimes people end up in higher levels of care unintentionally—and this was one of those cases.
The problem? In assisted living, medication management is handled for you. At home, you’re on your own.
When he was discharged, the facility handed the family a trash bag full of medications and a medication list. That’s it.
During our intake visit, I sat down with the family at their dining room table, and we sorted through everything. I asked questions: “Why is he taking this? What’s this one for?” They started pulling out medications from home they’d saved—medications that had never been discontinued, just… added to.
We were looking at 45+ medications.
The family was distraught. “Maybe moving home was the wrong decision. He’s so confused. He sleeps all the time. He’s not himself.”
I looked at the list and saw the usual suspects: diphenhydramine (Benadryl), alprazolam (Xanax), gabapentin three times a day, oxybutynin for bladder control, and three different blood pressure medications.
The family took the entire bag of medications to their PCP armed with questions. After that visit, the doctor made adjustments—discontinuing duplicates, reducing doses, eliminating unnecessary sedatives.
Within a few weeks, the family called me: “Dad is with it again.”
He didn’t need assisted living. He needed a medication review.
What Families Should Bring to Any Memory Evaluation
If your loved one is scheduled for a memory screen or cognitive evaluation, don’t just show up with questions. Show up with information.
Here’s what I recommend bringing:
1. Every medication—and I mean every medication
Bring the actual pill bottles, not just a printed list. Include:
- Prescription medications (even the ones they “don’t take anymore”)
- Over-the-counter medications (allergy pills, sleep aids, pain relievers)
- Vitamins and supplements
- That random cream or eye drop they use occasionally
If they use multiple pharmacies, bring medications from all of them. You’d be surprised how often duplication hides in plain sight.
2. A 30-day snapshot
Keep a simple log for the month leading up to the evaluation:
- Missed doses or dosing confusion
- New side effects (falls, confusion, dizziness, sleep changes)
- Any medication changes or new prescriptions
This gives the provider context they wouldn’t otherwise have.
3. Recent vital signs (if available)
If you’ve been tracking anything at home, bring it:
- Blood pressure readings (seated and standing if possible)
- Blood sugar logs or CGM data
- Weight trends (especially if heart failure is a concern)
4. Hearing aids and glasses
This seems obvious, but I’ve seen too many memory screens conducted without them. Cognitive tests rely on hearing instructions and reading visual cues. If your loved one can’t hear or see clearly, the score will tank—and it won’t reflect their actual cognition.
Make sure batteries are fresh and glasses are clean.
5. Notes on sleep, hydration, and timing
When was the last good night’s sleep? Are they eating regularly? Drinking enough water? Did they take their medications the morning of the test?
All of this matters. A tired, dehydrated person with peak sedation from last night’s sleep aid will score poorly—even if their memory is fine.
Before You Panic About a Score
Memory screens are tools, not verdicts. They flag concerns—they don’t diagnose dementia.
If your loved one scores lower than expected, take a breath and call the MEDIC:
- Review their Medication burden
- Check for Errors and duplication
- Assess Dose and dynamics
- Look at Interactions and illness
- Consider Context and test conditions
Then optimize what you can, work with their doctor, and re-screen in 4–6 weeks under better conditions.
You might be surprised how much those numbers improve.
Frequently Asked Questions (FAQs):
Can medications really cause false dementia symptoms?
Yes. Anticholinergic and sedative medications can drop memory screen scores by 4-5 points or more, creating symptoms that look like cognitive decline. The difference? Medication-related confusion is reversible once the burden is reduced.
How long after adjusting medications will scores improve?
Most improvements show up within 2-6 weeks after optimizing medications. Some changes—like better alertness and reduced confusion—can appear within days, but cognitive test scores typically need a month or more to reflect the full benefit.
Should I stop medications before a memory test?
Never stop medications without consulting your doctor. Abrupt discontinuation—especially of benzodiazepines, antidepressants, or blood pressure medications—can be dangerous. Instead, bring the complete medication list to your appointment and ask about optimization.
What’s the most common medication culprit you see?
Diphenhydramine (Benadryl) tops the list. It’s in dozens of over-the-counter sleep aids, allergy medications, and “PM” combination products. Families often don’t realize they’re giving a potent anticholinergic every night. Oxybutynin for overactive bladder is a close second.
My loved one has been on these medications for years. Why is it a problem now?
Aging changes how the body processes medications. Kidney and liver function decline, making drugs accumulate more easily. Medications that were safe at 65 may cause problems at 85. Additionally, as more medications are added over time, the cumulative burden increases even if individual doses stay the same.
Will insurance cover a medication review?
At Options for Senior America, we include a complimentary medication review as part of our home care intake—no insurance needed. For formal clinical medication therapy management (MTM), many Medicare Part D plans do cover pharmacist consultations. Check your plan or ask your pharmacist.
What if the doctor says the medications are necessary?
Sometimes they are. The goal isn’t to eliminate all medications; it is to optimize the regimen. Often there are lower-burden alternatives (like mirabegron instead of oxybutynin, or trazodone instead of diphenhydramine for sleep). A good pharmacist can help identify safer options to discuss with the prescriber.
Can home care agencies really help with medication issues?
Most can’t—but we can. As a pharmacist-owned agency, Options for Senior America is the only home care provider in North Carolina with this level of medication expertise built in. Our caregivers are trained to spot red flags, and I personally review medication lists during intake. We can’t change prescriptions, but we can give families the right questions to ask their doctors.
At Options for Senior America, we include a complimentary medication review as part of our intake process. We can’t adjust prescriptions (we’re not medical providers), but we can help families spot red flags and ask the right questions. Sometimes that’s all it takes to turn “confusion” back into clarity.
If you’re in the Greensboro or Burlington area and want a second set of eyes on a loved one’s medication list, contact us here. It’s what we do.
