22 March 2009

Risk of cognitive decline from use medications targeting central nervous system

Central nervous system medications and cognitive decline
Dementia News (Alzheimer’s Australia): 20 March 2009
Older adults are commonly prescribed medications that are targeted at the central nervous system. These include benzodiazepines, opioids, antidepressants, and antipsychotics. These medications have adverse effects, which include problems with mobility, falls, and cognition. Cognitive problems may be reversed by adjusting or discontinuing these medications. The question of whether there is an association between the combined use of multiple medications affecting the central nervous system and cognitive change over time was investigated in a group of 2737 adults aged 65 years or older who were participants in the longitudinal Health, Aging and Body Composition Study begun in Pittsburgh and Memphis in 1997–98. Study participants were healthy at the beginning of the study and were evaluated annually.

To begin, researchers from the University of Pittsburgh and the University of Tennessee took details on participants’ medications and their dosages and duration of use. Cognitive function was also measured; all participants were cognitively normal. These measures were taken again in Years 3 and 5. By Year 5, 7.7% of participants were diagnosed with incident cognitive impairment, and 25.2% demonstrated cognitive decline. Over that time the proportion of participants using central nervous system medications increased from 13.9% at the beginning of the study to 15.3% by the third year and 17.1% by the fifth year.

The use of combined medications for the central nervous system was found to be associated with cognitive decline, but not with incident cognitive impairment. Furthermore, the higher the doses and the longer the period over which they were taken, the greater the risk of cognitive decline appeared to be. Given these findings, the researchers recommend that studies be undertaken to explore the effects of using combined medications for the central nervous system on older adults who are especially vulnerable, such as those who are residents in long-term care facilities.

Reference: Wright RM; Roumani YF; Boudreau R; Newman AB; Ruby CM; Studenski SA; Shorr RI; Bauer DC; Simonsick EM; Hilmer SN; Hanlon JT (2009). 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. Journal of the American Geriatrics Society 57(2):243–250.

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