Podcast episode
366: Can Over-the-Counter Meds Cause Dementia?
dementia-prevention healthcare medication-safety
TL;DR
Dementia care expert Teepa Snow addresses a viral-style headline claiming certain over-the-counter medications dramatically raise dementia risk. She says the evidence is genuinely mixed, names Benadryl (diphenhydramine) as a drug worth avoiding when alternatives exist, and points caregivers toward the Beers List as a practical tool for reviewing medications in older adults. The episode is brief and light on detail.
What was covered
- The headline claim: Host Greg Phelps raised a web article asserting that two unnamed OTC medications can shrink the brain's memory center by more than 28% within a year and 49% within two years, with a 44% increase in dementia risk.
- Teepa Snow's pushback on the framing: She said the relationship between these drugs and dementia is contested — looking across ten studies, you'll find results pointing in both directions. Her position: these drugs make your brain work poorly; whether that rises to causing dementia after years of use is still argued.
- Benadryl (diphenhydramine) specifically: Snow named Benadryl — found in many allergy and sleep OTC products — as a drug she has long cautioned against. Its mechanism: it blocks acetylcholine activity in the brain. Acetylcholine is a neurotransmitter critical to memory and cognition; drugs that suppress it (called anticholinergics) are a known concern in older adults.
- Bladder medications as another example: Snow noted that some medications used to control bladder leakage carry similar trade-offs — they may improve one symptom while impairing brain function. She framed this as a broader question: is the benefit worth the neurological cost?
- The Beers List: Snow recommended that families dealing with a loved one on multiple medications seek out a geriatric pharmacist or geriatrician familiar with the Beers Criteria — a published list of medications considered potentially inappropriate or risky for older adults. She noted that not all physicians keep current with updates to the list.
- Medication disposal: Snow flagged that flushing old medications down the toilet introduces them into the water supply; she recommended using a proper drug take-back location instead.
Notable claims & predictions
- Teepa Snow on Benadryl: "It doesn't cause dementia. It causes your brain to not work well. Now, if you do it over years and years, yeah, probably your risk is higher." — A careful distinction between short-term cognitive impairment and long-term dementia risk.
- Snow on the evidence base: "You look at 10 studies, you'll see some saying one thing, some saying the other." — She is explicitly describing a contested, not settled, area of research.
- Snow on acetylcholine: "Taking anything with Benadryl limits acetylcholine activity. So you want to be super thoughtful about it and look for alternatives." — A practical rule: if an OTC product contains diphenhydramine and there is an alternative without it, choose the alternative.
- Snow on the Beers List: "Not all physicians are keeping up with changes in the beers list… there have been some shifts on what they recommend." — A prompt to not assume your doctor's prescribing reflects the latest guidance.
- Snow on polypharmacy: Her anecdote about a cousin reviewing her grandmother's "traveling pharmacy" — removing several medications — after which the grandmother's health improved, illustrates that more medications is not always better for older adults.
Fact check
The 44% dementia-risk increase / 28–49% hippocampal shrinkage figures: These numbers were introduced by Greg Phelps from an unnamed web article, not from a peer-reviewed source named in the episode. Snow neither confirmed nor verified them; she responded with general caution about anticholinergics rather than endorsing the statistics. The specific figures are unverified in the context of this episode — readers should not treat them as established fact. Sensational headlines about brain-shrinkage percentages frequently outrun the underlying studies.
Benadryl and acetylcholine: Snow's claim that diphenhydramine (Benadryl) suppresses acetylcholine activity is accurate — diphenhydramine is a first-generation antihistamine with well-documented anticholinergic properties, and anticholinergic burden in older adults is a legitimate clinical concern. Her characterization of the dementia-causation evidence as mixed is fair; the research literature is genuinely contested rather than settled.
The Beers Criteria: Snow's description is accurate. The American Geriatrics Society publishes and periodically updates the Beers Criteria, which flags medications with unfavorable risk-benefit profiles in adults aged 65 and older. Many anticholinergic drugs, including diphenhydramine, appear on it. Her note that not all physicians stay current with updates is a reasonable clinical observation, not a verifiable fact, but not implausible.
Medication flushing and water supply: Snow's caution about flushing medications is consistent with guidance from U.S. environmental and health agencies, though she did not cite a specific source.
No claims that clearly fail scrutiny — the episode's main risk is the unverified headline numbers Greg Phelps introduced, and Snow herself did not endorse them.
Why this matters for you
- Check your medicine cabinet for diphenhydramine. It appears under many brand names beyond Benadryl — look for it in nighttime cold remedies, sleep aids (ZzzQuil, Unisom SleepTabs, Tylenol PM, and similar), and allergy products. If you or someone you care for takes these regularly, ask a pharmacist whether an alternative without anticholinergic effects is available.
- If your loved one sees multiple doctors, a medication review is worth requesting. Snow specifically recommends a geriatric pharmacist or a geriatrician familiar with the Beers Criteria. Polypharmacy — being on many drugs from different prescribers — raises the risk that no single clinician has a complete picture.
- The Beers List is a real document you can look up. Published by the American Geriatrics Society, it is publicly available and can help you frame a conversation with a doctor about whether a specific drug is appropriate for an older adult — including yourself.
- Interesting, but limited actionability this week. The episode is short and does not go deep. The core takeaway — be cautious about anticholinergic OTC drugs, get a medication review if polypharmacy is in play — is genuinely useful, but there is little new research or specific guidance beyond that.
Analysis
Showing the shorter version.
Teepa Snow, a dementia care specialist, pushed back on a viral-style headline claiming certain OTC medications shrink the brain's memory center by 28% within a year and 49% within two years, with a 44% increase in dementia risk. Snow neither confirmed nor denied those figures. Host Greg Phelps pulled them from an unnamed web article, not a peer-reviewed source, and Snow's response was general caution rather than endorsement. Treat those numbers as unverified.
Her actual point is more useful and better grounded. Benadryl (diphenhydramine) suppresses acetylcholine, a neurotransmitter central to memory and cognition. Drugs that do this are called anticholinergics, and their effects in older adults are a real clinical concern. Snow's position on dementia causation is careful: these drugs make the brain work poorly in the short term, and years of use probably raise dementia risk, but the research is contested. Look at ten studies, she said, and they don't all point the same direction.
Diphenhydramine shows up in more products than most people realize: nighttime cold remedies, sleep aids like ZzzQuil, Unisom SleepTabs, and Tylenol PM, plus standard allergy products. Snow's practical rule is to look for an alternative without it whenever one exists.
The same trade-off applies to some bladder medications, which Snow flagged as another category where a drug may fix one symptom while quietly costing something in cognition.
On polypharmacy, Snow recommended asking a geriatric pharmacist or a geriatrician who knows the Beers Criteria to review the full medication list. The Beers Criteria, published by the American Geriatrics Society and updated periodically, flags medications with poor risk-benefit profiles in adults 65 and older. Many anticholinergics, diphenhydramine included, are on it. Snow noted that not all physicians stay current with the list's updates, which is worth knowing if you are assuming your doctor's current prescribing reflects the latest guidance.
Her anecdote about a family member reviewing a grandmother's medications and removing several of them, after which the grandmother improved, is not data. But the underlying point is solid: more medications prescribed by multiple doctors, with no single clinician looking at the whole picture, is a known risk pattern.
One small practical note Snow added: flushing old medications down the toilet puts them into the water supply. Use a drug take-back location instead.
Dementia care expert Teepa Snow addresses a viral-style headline claiming certain over-the-counter medications dramatically raise dementia risk. She says the evidence is genuinely mixed, names Benadryl (diphenhydramine) as a drug worth avoiding when alternatives exist, and points caregivers toward the Beers List as a practical tool for reviewing medications in older adults. The episode is brief and light on detail.
What was covered
- The headline claim: Host Greg Phelps raised a web article asserting that two unnamed OTC medications can shrink the brain's memory center by more than 28% within a year and 49% within two years, with a 44% increase in dementia risk.
- Teepa Snow's pushback on the framing: She said the relationship between these drugs and dementia is contested — looking across ten studies, you'll find results pointing in both directions. Her position: these drugs make your brain work poorly; whether that rises to causing dementia after years of use is still argued.
- Benadryl (diphenhydramine) specifically: Snow named Benadryl — found in many allergy and sleep OTC products — as a drug she has long cautioned against. Its mechanism: it blocks acetylcholine activity in the brain. Acetylcholine is a neurotransmitter critical to memory and cognition; drugs that suppress it (called anticholinergics) are a known concern in older adults.
- Bladder medications as another example: Snow noted that some medications used to control bladder leakage carry similar trade-offs — they may improve one symptom while impairing brain function. She framed this as a broader question: is the benefit worth the neurological cost?
- The Beers List: Snow recommended that families dealing with a loved one on multiple medications seek out a geriatric pharmacist or geriatrician familiar with the Beers Criteria — a published list of medications considered potentially inappropriate or risky for older adults. She noted that not all physicians keep current with updates to the list.
- Medication disposal: Snow flagged that flushing old medications down the toilet introduces them into the water supply; she recommended using a proper drug take-back location instead.
Notable claims & predictions
- Teepa Snow on Benadryl: "It doesn't cause dementia. It causes your brain to not work well. Now, if you do it over years and years, yeah, probably your risk is higher." — A careful distinction between short-term cognitive impairment and long-term dementia risk.
- Snow on the evidence base: "You look at 10 studies, you'll see some saying one thing, some saying the other." — She is explicitly describing a contested, not settled, area of research.
- Snow on acetylcholine: "Taking anything with Benadryl limits acetylcholine activity. So you want to be super thoughtful about it and look for alternatives." — A practical rule: if an OTC product contains diphenhydramine and there is an alternative without it, choose the alternative.
- Snow on the Beers List: "Not all physicians are keeping up with changes in the beers list… there have been some shifts on what they recommend." — A prompt to not assume your doctor's prescribing reflects the latest guidance.
- Snow on polypharmacy: Her anecdote about a cousin reviewing her grandmother's "traveling pharmacy" — removing several medications — after which the grandmother's health improved, illustrates that more medications is not always better for older adults.
Fact check
The 44% dementia-risk increase / 28–49% hippocampal shrinkage figures: These numbers were introduced by Greg Phelps from an unnamed web article, not from a peer-reviewed source named in the episode. Snow neither confirmed nor verified them; she responded with general caution about anticholinergics rather than endorsing the statistics. The specific figures are unverified in the context of this episode — readers should not treat them as established fact. Sensational headlines about brain-shrinkage percentages frequently outrun the underlying studies.
Benadryl and acetylcholine: Snow's claim that diphenhydramine (Benadryl) suppresses acetylcholine activity is accurate — diphenhydramine is a first-generation antihistamine with well-documented anticholinergic properties, and anticholinergic burden in older adults is a legitimate clinical concern. Her characterization of the dementia-causation evidence as mixed is fair; the research literature is genuinely contested rather than settled.
The Beers Criteria: Snow's description is accurate. The American Geriatrics Society publishes and periodically updates the Beers Criteria, which flags medications with unfavorable risk-benefit profiles in adults aged 65 and older. Many anticholinergic drugs, including diphenhydramine, appear on it. Her note that not all physicians stay current with updates is a reasonable clinical observation, not a verifiable fact, but not implausible.
Medication flushing and water supply: Snow's caution about flushing medications is consistent with guidance from U.S. environmental and health agencies, though she did not cite a specific source.
No claims that clearly fail scrutiny — the episode's main risk is the unverified headline numbers Greg Phelps introduced, and Snow herself did not endorse them.
Why this matters for you
- Check your medicine cabinet for diphenhydramine. It appears under many brand names beyond Benadryl — look for it in nighttime cold remedies, sleep aids (ZzzQuil, Unisom SleepTabs, Tylenol PM, and similar), and allergy products. If you or someone you care for takes these regularly, ask a pharmacist whether an alternative without anticholinergic effects is available.
- If your loved one sees multiple doctors, a medication review is worth requesting. Snow specifically recommends a geriatric pharmacist or a geriatrician familiar with the Beers Criteria. Polypharmacy — being on many drugs from different prescribers — raises the risk that no single clinician has a complete picture.
- The Beers List is a real document you can look up. Published by the American Geriatrics Society, it is publicly available and can help you frame a conversation with a doctor about whether a specific drug is appropriate for an older adult — including yourself.
- Interesting, but limited actionability this week. The episode is short and does not go deep. The core takeaway — be cautious about anticholinergic OTC drugs, get a medication review if polypharmacy is in play — is genuinely useful, but there is little new research or specific guidance beyond that.
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