Article

Effect of Central Nervous System Medication Use on Decline in Cognition in Community-Dwelling Older Adults: Findings from the Health, Aging and Body Composition Study

Department of Medicine, University of Pittsburgh, Pennsylvania 15213, USA.
Journal of the American Geriatrics Society (Impact Factor: 4.22). 03/2009; 57(2):243-50. DOI: 10.1111/j.1532-5415.2008.02127.x
Source: PubMed

ABSTRACT To evaluate whether combined use of multiple central nervous system (CNS) medications over time is associated with cognitive change.
Longitudinal cohort study.
Pittsburgh, Pennsylvania, and Memphis, Tennessee.
Two thousand seven hundred thirty-seven healthy adults (aged > or =65) enrolled in the Health, Aging and Body Composition study without baseline cognitive impairment (modified Mini-Mental State Examination (3MS) score > or =80).
CNS medication (benzodiazepine- and opioid-receptor agonists, antipsychotics, antidepressants) use, duration, and dose were determined at baseline (Year 1) and Years 3 and 5. Cognitive function was measured using the 3MS at baseline and Years 3 and 5. The outcome variables were incident cognitive impairment (3MS score <80) and cognitive decline (> or =5-point decline on 3MS). Multivariable interval-censored survival analyses were conducted.
By Year 5, 7.7% of subjects had incident cognitive impairment; 25.2% demonstrated cognitive decline. CNS medication use increased from 13.9% at baseline to 15.3% and 17.1% at Years 3 and 5, respectively. It was not associated with incident cognitive impairment (adjusted hazard ratio (adj HR)=1.11, 95% confidence interval (CI)=0.73-1.69) but was associated with cognitive decline (adj HR 1.37, 95% CI=1.11-1.70). Longer duration (adj HR=1.39, CI=1.08-1.79) and higher doses (>3 standardized daily doses) (adj HR=1.87, 95% CI=1.25-2.79) of CNS medications suggested greater risk of cognitive decline than with nonuse.
Combined use of CNS medications, especially at higher doses, appears to be associated with cognitive decline in older adults. Future studies must explore the effect of combined CNS medication use on vulnerable older adults.

0 Followers
 · 
122 Views
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Anticholinergic and sedative medications are commonly used in older adults and are associated with adverse clinical outcomes. The Drug Burden Index was developed to measure the cumulative exposure to these medications in older adults and its impact on physical and cognitive function. This narrative review discusses the research and clinical applications of the Drug Burden Index, and its advantages and limitations, compared with other pharmacologically developed measures of high-risk prescribing.
    Clinical Interventions in Aging 09/2014; 9:1503-1515. DOI:10.2147/CIA.S66660 · 1.82 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Objective To know the prevalence and factors associated to low cognitive performance in a representative sample of the adult population in a society aging progressively. Method Cross-sectional population-based study carried out in a three-stage sampling: 81 census tracts (primary sampling unity) were randomly selected, followed by 1,672 households and 2,471 participants (weighted sample) corresponding to the second and third stages, respectively. The outcome prevalence was calculated according sociodemographic, behavioral and health related variables. Crude and adjusted prevalence ratios were estimated using Poisson regression. Results The prevalence of low cognitive performance was high, mainly among females, and indicated linear trends into categories of age, schooling, income, plasma fibrinogen and self-reported health status. In multivariate models, gender, diabetes, fibrinogen and self-reported health status presented positive associations, while schooling, employment and sitting time presented negative associations with the outcome. Conclusion Interventions related to diabetes and fibrinogen levels control as well as improvement in health care might delay low cognitive performance in societies aging progressively as such the study population.
    Arquivos de Neuro-Psiquiatria 01/2015; 73(1):22-9. DOI:10.1590/0004-282X20140189 · 1.01 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Growing evidence shows a high correlation between extensive use of central nervous system-acting drugs (CNSADs) in elderly patients and adverse drug reactions (ADRs) such as falls, fractures, and mortality. Are results of cognitive testing with the Mini Mental Status Examination (MMSE) influenced by use of CNSADs? Geriatric inpatient service for acute, subacute, and rehabilitation care. Secondary combined analysis of two prospective, single-center study cohorts (PROPSYC, 2011 and AGE OUT, 2012) with identical procedure for the MMSE at a tertiary hospital. Overall, 395 patients were included, 144 male (M) and 251 female (F). Mean age was 80.0 +/- 8.4 years (M 76.7 +/- 9.1, F 81.9 +/- 7.3, p = 0.0000). Mean MMSE points were 22.9 +/- 4.8 (M 23.2 +/- 4.6, F 22.6 +/- 5.0, p = 0.211). In total, 258 patients (65.3 %) used drugs with potential adverse cognitive properties. Analgesics with central activity were given to 117 of 395 patients (29.6 %). Low-potency opioids (tramadol hydrochloride, tilidine) were identified in 60 patients and high-potency opioids in 57 patients. Antidepressants were used in 66 patients, benzodiazepines in 26, and hypnotics in 11, while 38 patients received other CNSADs. We only found significant correlations with the results of cognitive testing for sedatives (diazepam and oxazepam, Pearson's r -aEuro parts per thousand 0.79, p = 0.05), but not for lorazepam. Our analysis shows an influence of sedatives (diazepam and oxazepam, but not lorazepam) on cognitive testing with the MMSE in users of CNSADs.
    Zeitschrift für Gerontologie + Geriatrie 06/2014; 47(4):279-284. DOI:10.1007/s00391-014-0654-5 · 1.02 Impact Factor

Full-text (2 Sources)

Download
31 Downloads
Available from
May 22, 2014