Inappropriate Drug Use in People with Cognitive Impairment and Dementia: A Systematic Review

Abstract

The aim of this systematic review was to identify, assess and summarize studies about potentially inappropriate drug use (IDU) in cognitive impairment and dementia and to present findings about whether cognitive impairment and dementia are associated with IDU. The search was made in Medline/PubMed using free terms in the title or abstract. The inclusion criteria were: English language, published until 1 March 2014, original quantitative study and assessment of overall IDU with a consensus based summarized measure. Exclusion criteria were: focus on specific patient group (other than cognitive impairment or dementia), focus on specific drug class and failure to present a prevalence measure of IDU or an effect estimate (i.e. odds ratio). Of the initial 182 studies found in Medline, 22 articles fulfilled the criteria. Most studies used the Beers criteria for assessment of IDU. Prevalence of IDU among individuals with cognitive impairment or dementia ranged from 10.2% to 56.4% and was higher in nursing home settings than in community-dwelling samples. Most studies reported a lower likelihood of IDU in case of cognitive impairment or dementia. To conclude, IDU is highly prevalent among persons with cognitive impairment and dementia, although these conditions seem to be associated with a lower probability of IDU. This might reflect an awareness among clinicians of cautious prescribing to this vulnerable group of patients. More studies on large cohorts of persons with cognitive impairment and dementia are needed to draw conclusions about optimal drug prescribing to this frail group of older persons.

Potentially Inappropriate Medication in Community-Dwelling Primary Care Patients who were Screened Positive for Dementia

“…The severity of cognitive impairment (measured by the MMSE score) was not associated with the risk of taking a Priscus PIM in our analysis. This result agrees with previous German and international studies that also failed to find associations between cognitive impairments or dementia and PIM use [49]. …”

Potentially inappropriate prescribing in people with dementia: An Australian population‐based study

“…In addition, STOPP-listed PIP involving nonsteroidal anti-inflammatory drugs (NSAIDs) were more frequent in people not dispensed medicines for dementia than people dispensed medicines for dementia, including long-term use of NSAIDs (11.3% vs 7.2%, P < .0001) ( green list) higher than that of participants without dementia. 26 In a study from the United States involving participants diagnosed with incident dementia and those without dementia, the prevalence of PIMs use in the 1-year period post diagnosis, as defined by the 2015 Beers criteria, was 69% in people with dementia versus 74% in those without dementia. 25 In contrast, a systematic review looking at PIP in people with dementia found that dementia was associated with a decrease in the likelihood of PIMs.…”

Frailty and Potentially Inappropriate Medication Use at Nursing Home Transition

“…12 Previous studies have shown that frailty is associated with use of higher medication numbers and select drug classes, which may increase the risk of adverse drug events. 13,14 An extensive literature describes indicators of PIM use and prevalence in the nursing home, and characteristics associated with PIM prescribing, [15][16][17][18][19] but few studies have examined use of these medications during transition to nursing homes or in relation to frailty. Whether older adults enter nursing homes on these drugs (and whether any effort is made to discontinue PIMs following entry) or whether PIMs are introduced in nursing homes is of importance, particularly if patterns differ by frailty status.…”