Chronic high-dose dimenhydrinate use contributing to early multifactorial cognitive impairment

Area of Science:

• Pharmacology
• Neuroscience
• Psychiatry

Background:

• Dimenhydrinate is a widely used over-the-counter medication for nausea and motion sickness.
• Anticholinergic medications are linked to dementia, but causality remains unclear.
• Chronic misuse of anticholinergic agents raises concerns for cognitive impairment.

Observation:

• A woman in her 40s with a history of daily, high-dose dimenhydrinate abuse presented with minor neurocognitive disorder and delusional beliefs.
• Her presentation was complex, with confounding factors including a presumed learning disability, autoimmune disease treatment, and cannabis use.
• Standard medical workup yielded normal results, and she did not respond to antipsychotic treatment.

Findings:

• This case suggests a potential link between chronic, high-dose dimenhydrinate misuse and the development of significant cognitive deficits and psychosis.
• The observed cognitive deficits and delusional beliefs in a relatively young individual challenge the notion that such effects are exclusive to the elderly.
• The lack of response to antipsychotics indicates the cognitive impairment may be directly related to anticholinergic toxicity.

Implications:

• This case adds to the evidence suggesting that chronic misuse of anticholinergic medications like dimenhydrinate may lead to potentially irreversible cognitive impairment.
• Healthcare providers should be aware of the neuropsychiatric risks associated with long-term, high-dose use of dimenhydrinate, particularly in cases of substance abuse.
• Further research is warranted to understand the mechanisms and long-term consequences of dimenhydrinate neurotoxicity.