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

Abstract

Objectives To evaluate whether combined use of multiple central nervous system (CNS) medications over time is associated with cognitive change. Design Longitudinal cohort study. Setting Pittsburgh, PA and Memphis, TN. Participants 2737 healthy adults (aged ≥ 65) enrolled in the Health, Aging and Body Composition study without baseline cognitive impairment (modified Mini-Mental Status [3MS] score >80). Measurements 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 with the 3MS at baseline, years 3 and 5. The outcome variables were incident cognitive impairment (3MS score< 80) and cognitive decline (≥5 point decline on 3MS). Multivariable interval-censored survival analyses were conducted. Results By year 5, 7.7% 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). Compared to non-use, 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. Conclusion 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.

An Evaluation of the Central Nervous System Medication Use and Frailty among Residents of Aged Care Homes in Malaysia

“…The number of CNS medications per subject correlated significantly with the GFI score. This is consistent with the findings of Wright et al [68] who reported that the combined use of CNS medications in older adults leads to decline in cognitive function, which is one of the frailty indicators in GFI. Slight improvements in GFI score at 3 months with some proportion of participants who were frail transitioning into better frailty status could be a reflection of modest reduction in the mean number of CNS medications per participant (0.8-0.5 medications per resident) in the same period.…”

Control of diabetes and fibrinogen levels as well as improvement in health care might delay low cognitive performance in societies aging progressively

“…However, in spite of this limitation it might be plausible to suppose that those conditions were considered, even indirectly, by mean of data related to CNS medications which included antidepressants, anxiolytics, anticonvulsants, antipsychotics, hypnotics and opiates. With regard to the last, the present study confirmed the findings reported by Rollin et al 29 in the Health Aging and Body Composition Study cohort (Health ABC), in which no association between LCP and CNS medications was found (adjusted hazard ratio = 1.11; 95%CI: 0.73-1.69). On the other hand, the effect of hypertension on cognitive decline, which could be observed in cohort studies 16 , was not confirmed in the present study, even so associations between LCP and hypertension or coronary heart disease would be expected.…”

Fatores associados ao uso de psicotrópicos por idosos residentes no Município de São Paulo

“…Its use, however, requires caution since it may worsen an individual's condition in the presence of cognitive decline. The use of psychotropic agents for more than two years and the consumption of high dosages increase the risk of cognitive decline in 39% and 87% of patients, respectively (21) . These aspects were not confirmed in this study given its design, however.…”