Polypharmacy Cut-Off for Gait and Cognitive Impairments

Abstract

Background: Polypharmacy is a well-established risk factor for falls, and these are one of the major health problems that affect the quality of life as people age. However, the risk of mobility and cognitive impairments consecutive to polypharmacy has been little addressed, despite the association between these adverse outcomes and falls. Moreover, the rare polypharmacy cut-offs were all but one arbitrarily determined.Objective: Studying relationships between polypharmacy and both mobility and cognitive impairments, and statistically determining a cut-off point in the number of medicinal molecule beyond which polypharmacy has deleterious consequences with respect to mobility and cognitive impairment.Methods: We enrolled 113 community-dwelling adults aged 55 years and older with a fall history, with or without injury, in the previous year. We carefully collected information about daily medicinal molecules taken. We assessed basic mobility and global cognition with the Time-Up-and-Go and the Montreal Cognitive Assessment (MoCA) test, respectively (clinicaltrials.gov NCT02292316).Results: Timed-Up and Go test and MoCA scores were both significantly correlated with the number of molecule, used. Receiver Operating Characteristic curves indicate, with high prediction (p < 0.002), that daily consumption of five or more molecules is associated with risk for both impaired mobility and global cognition. These relationships were independent of the number of comorbidities and of the pharmacological class.Conclusion: Community-dwelling adults aged 55 years and older who take five or more daily medicinal molecules are at high risk for both mobility and cognitive impairments. Physicians and patients should be aware of these new findings, especially when there are multiple prescribers involved in the care of the patient.

Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility

“…Thus, consuming two or more psychotropic molecules impaired global cognition and mobility in an independent manner. Interestingly, a similar finding has been reported for polypharmacy, with a cut-off of 5 medicinal molecules (Langeard et al, 2016). This was, however, not the case when focusing on executive function rather than on global cognition.…”

“…A major strength of the present study is the identification of a threshold value of two psychotropic molecules for both impaired cognition and mobility, with a 3-to 10-fold increased risk for cognitive impairment, and a 4-fold increased risk for mobility impairment. This threshold of two psychotropic molecules indicates that psychotropic drugs are highly involved in the risk for impaired mobility and global cognition following polypharmacy (Langeard et al, 2016). Furthermore and interestingly, this threshold of two psychotropic molecules was found here in a relatively healthy population that included both young and old seniors, and for all impaired cognitive and mobility scores, independent of confounding factors, including comorbidities.…”

“…Polypharmacy increases the risk of falls by as much as five times (Montero-Odasso et al, 2005;Woolcott et al, 2009;de Groot et al, 2013;Montero-Odasso et al, 2019), in part through gait disturbances (Montero-Odasso et al, 2019). Polypharmacy also impairs cognition (Langeard et al, 2016;Rawle et al, 2018). Yet, association between low cognitive abilities and increased risk of falling is well-known (Herman et al, 2010;Montero-Odasso et al, 2012;Li et al, 2018), which is consistent with the high interference of cognitive demands with postural control, widely demonstrated in both young and older adults (Lundin-Olsson et al, 1997), and even more so in old-old adults (Pothier et al, 2015).…”

“…Among the cognitive abilities, executive function would be preferentially involved in falls (Herman et al, 2010;Segev-Jacubovski et al, 2011;Hsu et al, 2012). We previously showed that community-dwelling older adults 55 years and over who took five or more medicinal molecules per day were at high risk for both impaired global cognition and mobility (Langeard et al, 2016); however, executive function and specific involvement of the different pharmacological classes were not investigated.…”

How Chronic Is Polypharmacy in Old Age? A Longitudinal Nationwide Cohort Study

“…30,36 One suggested reason for the fewer changes is that prescribers have the possibility to renew all drugs at once, which is not possible with ordinary prescriptions. 36 There currently exists no consensual definition of polypharmacy, but two aspects have been widely discussed: the number of drugs that define polypharmacy in a clinically meaningful way 37,38 and the criteria that would allow for drawing the line between appropriate and inappropriate polypharmacy. 20 These two dimensions, the intensity and the composition of polypharmacy, are important.…”