When the Medicine Takes the Memory: Anticholinergics, Benzodiazepines, and What Overprescription Costs Communities of Color

Memory is how the ancestors stay with us. When an elder loses the ability to remember, what is lost is not just personal history — it is the living archive of a family, a community, a set of survival strategies passed through generations. We do not grieve memory loss in isolation. We grieve it together, because what is held in one elder’s memory belongs to all of us.

Two classes of medication — anticholinergics and benzodiazepines — are among the most widely prescribed drugs in the United States, and among the most consistently linked to accelerated cognitive decline and increased dementia risk. They are also being prescribed, at documented disparate rates, to Black and Brown communities already carrying the neurological weight of weathering: the cumulative biological cost of navigating racism, poverty, and structural inequality. This piece is about what that convergence costs — and what genuine community-level cognitive health would need to look like to address it.

When an elder loses the ability to remember, what is lost is not just personal history — it is the living archive of a family, a community, a set of survival strategies passed through generations. Protecting cognitive health is not a wellness aspiration. It is an ancestral obligation.

What These Medications Do

Anticholinergic drugs work by blocking acetylcholine — a neurotransmitter essential for memory, attention, and muscle coordination. They are prescribed for a range of conditions: overactive bladder, COPD, Parkinson’s disease, and common allergies. Anticholinergic drugs carry several possible side effects including dry mouth, constipation, and vision problems — and most significantly, disruption to memory and cognitive clarity, because acetylcholine is also the neurotransmitter that keeps our brains functioning well.

Benzodiazepines — Valium, Ativan, Xanax, Klonopin — enhance the effect of GABA, slowing brain activity. They are prescribed for anxiety, insomnia, and seizures, and for short-term use they can be effective. Harvard Health has identified both anticholinergics and benzodiazepines as drugs to approach with caution for the sake of brain health. Long-term use of both drug classes has been consistently linked to changes in brain structure, accelerated cognitive aging, and dementia risk. Cumulative use of strong anticholinergic medications is associated with incident dementia. Anticholinergic medication use is associated with cognition decline, reduced brain metabolism, and brain atrophy in cognitively normal older adults.

Who Bears the Burden

The communities most at risk from these drug effects are communities that are already at higher risk for cognitive decline. Black Americans are approximately twice as likely to develop Alzheimer’s disease and other dementias as white Americans — a disparity that reflects not biological difference but the cumulative health consequences of structural racism, economic inequality, and reduced access to early intervention.

These same communities face prescribing patterns that research has documented as inconsistent with best practice. Rather than defaulting to non-pharmacological interventions first — which clinical guidelines recommend for anxiety and sleep disorders — patients in under-resourced healthcare settings often receive medication as the primary response. Safe deprescribing strategies for anticholinergic medications in older adults are underutilized — particularly in communities with the least access to specialty care. The result is that communities already carrying higher dementia risk are also more likely to remain on the drug classes that accelerate it.

The Weathering Connection

In 1992, Dr. Arline Geronimus proposed the weathering hypothesis: that the cumulative stress of navigating racism and structural inequality causes accelerated biological aging in Black Americans. The mechanism is measurable. Chronic stress activates the HPA (hypothalamic-pituitary-adrenal) axis, sustains elevated cortisol, triggers systemic inflammation, and gradually degrades cellular function. Research shows Black Americans carry, on average, shorter telomeres than white Americans of the same chronological age — not because of genetics, but because of the biological cost of racism.

This neurological vulnerability matters directly for medication safety. A brain already carrying the allostatic load of chronic racism and stress is more susceptible to the cognitive side effects of drugs that interfere with neurotransmitter systems. When anticholinergics block acetylcholine in a brain already stressed by years of high cortisol, the impact compounds. When benzodiazepines alter GABA production in a nervous system already taxed by chronic hypervigilance, the cognitive effects are not equivalent to those in a body that has not been asked to carry that weight. This is not a reason to refuse treatment. It is a reason to demand that prescribing decisions be made with this context explicitly named.

The implications for prescribing practice are significant and largely unaddressed. Standard pharmacokinetic studies that establish dosing guidelines are conducted predominantly on white male subjects. This means that the approved doses of many medications — including anticholinergics and benzodiazepines — have never been formally tested for safety in bodies carrying the chronic physiological burden of racial stress. We are, in effect, conducting an uncontrolled experiment on the most vulnerable members of our communities, without their informed consent.

Memory as Ancestral Responsibility

The neuroscience of inherited memory and the body’s stored knowledge tells us that memory is not merely individual. It is the medium through which communities transmit what they know about survival, love, and the specific geography of their world. When an elder loses their memory to dementia that might have been delayed or prevented with more careful medical decisions, what is lost is not only their personal history. It is a living archive — the specific knowledge of a community’s resilience, of how to get through the hard times, of who can be trusted and what has worked before.

Protecting cognitive health is not a wellness aspiration. In communities that have survived through what they carry and remember, it is an ancestral obligation. Our elders are not merely individuals whose health matters to them. They are living libraries. They are the keepers of what we need to survive what is coming next.

What Community Care Actually Requires

Individual behavior tips are not wrong — they are insufficient. Cognitive health at the community level requires prescribers who understand weathering and adjust risk-benefit analyses accordingly; formulary practices that default to non-pharmacological interventions first; community structures — multigenerational households, communal gathering, dense social relationship — that research consistently shows protect against cognitive decline more powerfully than any single medication. And the structural conditions — housing stability, food sovereignty, freedom from chronic stress — that make those protective practices possible in the first place.

Community health workers trained in both traditional healing practices and contemporary medicine are positioned to serve as bridges — helping families understand when a medication may be doing more harm than good, navigating the conversation with prescribers, and connecting elders to support structures that address the root conditions driving anxiety and sleeplessness in the first place. Ubuntu Village’s work in East Harlem is grounded in exactly this model: community health navigation that centers culture, relationship, and the long view of what it means to keep our people well.

Our ancestors did not have pharmacies. They had community. They had elders who were held in relationship, engaged in purpose, and embedded in belonging. The science of longevity confirms what they practiced. The science of cognitive decline confirms what we lose when that is taken away.

References

1. Anticholinergics: What You Need to Know — Medical News Today
2. Anticholinergics: Drug List, Side Effects, and More — Healthline
3. Benzodiazepine Abuse — WebMD
4. Two Types of Drugs You May Want to Avoid for the Sake of Your Brain — Harvard Health
5. Cumulative Use of Strong Anticholinergic Medications and Incident Dementia — PMC
6. Risacher SL et al. — Anticholinergic Medication Use and Cognition, Brain Metabolism, and Brain Atrophy. JAMA Neurology, 2016
7. Anticholinergic Medications in Older Adults and Strategies for Safe Deprescribing — Pharmacy Times
8. Benzodiazepines: Medical Uses, Side Effects, and Risks — Medical News Today
9. An Evidence-Based Update on Anticholinergic Use for Drug-Induced Movement Disorders — PMC

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Related Reading

• ‣ Epigenetics and Ancestral Memory: What Your Body Remembers
• ‣ The Body Keeps the Ancestors
• ‣ Mirror Neurons and Communal Healing
• ‣ The Neurobiology of Praise: Why Black Children Flourish

Michele Mitchell is the Founder, President & CEO of Ubuntu Village Inc., a 501(c)(3) nonprofit with programs in Kenya, Uganda, and Nigeria. A writer, advocate, and community strategist working at the intersection of ancestral wisdom, public health, and community power, Michele leads Ubuntu Village’s work to center communities as the protagonists of their own healing. She writes from the conviction that science and spirit are complementary, that healing is relational, and that community is the medicine. Read more about Michele, or connect with her on LinkedIn.