Even more concerning is the prescribing cascade. That’s when a new medication is added to treat the side effect of another, instead of questioning whether the original drug is still needed. A patient might get a medication causing dizziness, then a balance aid, then a sleep prescription for insomnia. Each new pill compounds the risk while the root cause goes unaddressed.
Fragmented healthcare makes it worse. Older adults often see multiple specialists, each focused on one area of the body. Without someone reviewing the complete medication list, dangerous combinations can slip through unnoticed. What seems safe alone can be harmful in combination, and an aging brain is especially vulnerable to these chemical stresses.
The consequences are serious. Adverse drug reactions are a leading cause of hospitalization for older adults. Cognitive side effects are often mistaken for irreversible dementia, causing unnecessary worry and misdiagnosis. But in many cases, adjusting or reducing medications can dramatically improve thinking and memory. This means some dementia cases may be preventable—or at least partially reversible.
Protecting brain health requires a new approach to medication management. Regular reviews of all prescriptions should be standard care for older adults. Patients and caregivers need to ask: Do I still need this? How does it interact with my other medications? Are there safer alternatives?
While dementia itself may not always be preventable, the hidden impact of medication overload offers a powerful opportunity. Addressing polypharmacy seriously can preserve cognitive function, reduce suffering, and improve quality of life for millions.
Are you or a loved one taking multiple medications? Talk to your doctor about reviewing your prescriptions—it could make a huge difference for your brain health.