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

Overview

Journal J Am Geriatr Soc

Specialty Geriatrics

Date 2009 Feb 12

PMID 19207141

Citations 59

Authors

Rollin M Wright

Yazan F Roumani

Robert Boudreau

Anne B Newman

Christine M Ruby

Stephanie A Studenski

Ronald I Shorr

Douglas C Bauer

Eleanor M Simonsick

Sarah N Hilmer

Joseph T Hanlon

Affiliations

Soon will be listed here.

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, Pennsylvania, and Memphis, Tennessee.

Participants: 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).

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 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.

Results: 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.

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.

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References

Francis J, Martin D, Kapoor W . A prospective study of delirium in hospitalized elderly. JAMA. 1990; 263(8):1097-101. View

Farrington C . Interval censored survival data: a generalized linear modelling approach. Stat Med. 1996; 15(3):283-92. DOI: 10.1002/(SICI)1097-0258(19960215)15:3<283::AID-SIM171>3.0.CO;2-T. View

Inouye S, Wagner D, Acampora D, Horwitz R, Cooney Jr L, Hurst L . A predictive index for functional decline in hospitalized elderly medical patients. J Gen Intern Med. 1993; 8(12):645-52. DOI: 10.1007/BF02598279. View

Morrison R, Magaziner J, Gilbert M, Koval K, McLaughlin M, Orosz G . Relationship between pain and opioid analgesics on the development of delirium following hip fracture. J Gerontol A Biol Sci Med Sci. 2003; 58(1):76-81. DOI: 10.1093/gerona/58.1.m76. View

Hayden K, Khachaturian A, Tschanz J, Corcoran C, Nortond M, Breitner J . Characteristics of a two-stage screen for incident dementia. J Clin Epidemiol. 2003; 56(11):1038-45. DOI: 10.1016/s0895-4356(03)00247-6. View

Pahor M, Chrischilles E, Guralnik J, Brown S, Wallace R, Carbonin P . Drug data coding and analysis in epidemiologic studies. Eur J Epidemiol. 1994; 10(4):405-11. DOI: 10.1007/BF01719664. View

Yaffe K, Lindquist K, Penninx B, Simonsick E, Pahor M, Kritchevsky S . Inflammatory markers and cognition in well-functioning African-American and white elders. Neurology. 2003; 61(1):76-80. DOI: 10.1212/01.wnl.0000073620.42047.d7. View

Inouye S, Viscoli C, Horwitz R, Hurst L, Tinetti M . A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med. 1993; 119(6):474-81. DOI: 10.7326/0003-4819-119-6-199309150-00005. View

McAlindon T, Wilson P, Aliabadi P, Weissman B, Felson D . Level of physical activity and the risk of radiographic and symptomatic knee osteoarthritis in the elderly: the Framingham study. Am J Med. 1999; 106(2):151-7. DOI: 10.1016/s0002-9343(98)00413-6. View

10.

Psaty B, Koepsell T, Lin D, Weiss N, Siscovick D, Rosendaal F . Assessment and control for confounding by indication in observational studies. J Am Geriatr Soc. 1999; 47(6):749-54. DOI: 10.1111/j.1532-5415.1999.tb01603.x. View

11.

Cao Y, Mager D, Simonsick E, Hilmer S, Ling S, Windham B . Physical and cognitive performance and burden of anticholinergics, sedatives, and ACE inhibitors in older women. Clin Pharmacol Ther. 2007; 83(3):422-9. DOI: 10.1038/sj.clpt.6100303. View

12.

Pompei P, Foreman M, Rudberg M, Inouye S, Braund V, Cassel C . Delirium in hospitalized older persons: outcomes and predictors. J Am Geriatr Soc. 1994; 42(8):809-15. DOI: 10.1111/j.1532-5415.1994.tb06551.x. View

13.

Beglinger L, Gaydos B, Tangphao-Daniels O, Duff K, Kareken D, Crawford J . Practice effects and the use of alternate forms in serial neuropsychological testing. Arch Clin Neuropsychol. 2005; 20(4):517-29. DOI: 10.1016/j.acn.2004.12.003. View

14.

Marcantonio E, Goldman L, Mangione C, Ludwig L, Muraca B, Haslauer C . A clinical prediction rule for delirium after elective noncardiac surgery. JAMA. 1994; 271(2):134-9. View

15.

Kooperberg C, Clarkson D . Hazard regression with interval-censored data. Biometrics. 1998; 53(4):1485-94. View

16.

Weiner D, Hanlon J, Studenski S . Effects of central nervous system polypharmacy on falls liability in community-dwelling elderly. Gerontology. 1998; 44(4):217-21. DOI: 10.1159/000022013. View

17.

Kamboj S, Tookman A, Jones L, Curran V . The effects of immediate-release morphine on cognitive functioning in patients receiving chronic opioid therapy in palliative care. Pain. 2005; 117(3):388-395. DOI: 10.1016/j.pain.2005.06.022. View

18.

Breteler M, van Swieten J, Bots M, Grobbee D, Claus J, van den Hout J . Cerebral white matter lesions, vascular risk factors, and cognitive function in a population-based study: the Rotterdam Study. Neurology. 1994; 44(7):1246-52. DOI: 10.1212/wnl.44.7.1246. View

19.

Bellamy N, BUCHANAN W, Goldsmith C, Campbell J, Stitt L . Validation study of WOMAC: a health status instrument for measuring clinically important patient relevant outcomes to antirheumatic drug therapy in patients with osteoarthritis of the hip or knee. J Rheumatol. 1988; 15(12):1833-40. View

20.

Inouye S, Charpentier P . Precipitating factors for delirium in hospitalized elderly persons. Predictive model and interrelationship with baseline vulnerability. JAMA. 1996; 275(11):852-7. View