Polypharmacy Associated with Cognitive Decline in Elderly Patients

Study finds that elderly patients taking at least 5 medications were at increased risk of mild cognitive impairment and dementia.

Peter Simons
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A new study from Taiwan has found that elderly patients taking at least 5 medications (known as polypharmacy) were at increased risk of mild cognitive impairment (MCI) as well as dementia. The research was led by Chia-Fen Tsai at Taipei Veterans General Hospital and was published in the Journal of Clinical Psychiatry.

According to the authors, polypharmacy has been associated with adverse drug reactions leading to falls, cognitive dysfunction, and death. Other studies have linked polypharmacy with increased risk for delirium and dementia. Tsai wanted to examine whether polypharmacy was also linked with MCI and dementia specifically.

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The study included 7,422 participants, all at least 65 years old, sampled from each district of Taiwan. The researchers conducted in-home interviews with each participant, a close relative, and a caregiver. They also examined prescription records and medication containers in the home to determine polypharmacy.

The researchers found that 9% of their cognitively healthy participants were taking 5 or more medications; 17% of those with MCI were, and 26% of those with dementia were doing so.

The researchers controlled for a number of possible confounding factors that have all been theorized to have an effect on cognitive functioning. They found that a number of factors have beneficial effects, while some factors have negative effects.

“Education, exercise, or social activity at least once per month, drinking tea, and having good sleep might have beneficial effects for cognitive capacity,” they write. “Age, polypharmacy, head injury, and cerebrovascular disease were associated with declined cognitive capacity.”

However, even after controlling for other factors, older patients on 5 or more medications were 1.75 times as likely to develop MCI, and more than twice as likely (2.33 times) to develop dementia, compared with those not on 5 or more medications.

Interestingly, the results were not significant for elderly patients with diabetes, hypertension, hyperlipidemia, or cerebrovascular disease. This could mean that polypharmacy is more beneficial than harmful in these instances, or it could mean that cognitive capacity is reduced so often in these instances that the effect of polypharmacy was minimal.

“Polypharmacy is common in the elderly and is associated with significantly lower cognitive capacity and higher risks of MCI and dementia, especially for persons without diabetes, hypertension, hyperlipidemia, or cerebrovascular diseases.”

The researchers suggest that physicians should promote healthy lifestyle habits that are associated with reduced risk of cognitive impairment, and that they should attempt to reduce medication prescriptions if possible.

 

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Cheng, C. M., Chang, W. H., Chiu, Y. C., Sun, Y., Lee, H. J., Tang, L. Y. . . . Tsai, C. F. (2018). Association of polypharmacy with mild cognitive impairment and cognitive ability: A nationwide survey in Taiwan. Journal of Clinical Psychiatry, 79(6), 17m12043. (Link)

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Peter Simons
MIA Research News Team: Peter Simons comes from a background in the humanities where he studied English, philosophy, and art. Now working on his PhD in Counseling Psychology, his recent research has focused on conflicts of interest in the psychopharmaceutical research literature, the use of antipsychotic medications in the treatment of depression, and the general philosophical and sociopolitical implications of psychiatric taxonomy in diagnosis and treatment.

8 COMMENTS

  1. Ask first: why are these old people taking drugs? Are they sick? Or are these drugs all supposed to prevent something? If they do prevent something, how likely was it in the first place and by how much do they reduce the risk? What are their side effects? What drugs are added to lessen the side effects? Yes, old people are being destroyed by pills.

    Eric C. Kutscher and Megan R. Leloux (2012) Psychopharmacology concerns in older individuals. Mental Health Clinician: May 2012, Vol. 1, No. 11, pp. 285-287.
    http://mhc.cpnp.org/doi/full/10.9740/mhc.n107159
    excerpt:
    Reports indicate that 25% of elderly inpatients and 30% of elderly outpatients will experience an adverse [drug] event. Unfortunately, many of these events are attributed to the use of multiple medications (polypharmacy). Ten to seventeen percent of hospital admissions for the elderly are directly related to adverse drug events and roughly half of the deaths in elderly patients [after such admissions, I think. Or?] are related to an adverse drug event. It is estimated that for each dollar spent on a medication, $1.33 is spent on the treatment of drug-related consequences.”

  2. My guess is these elderly people are taking all that crap because they’re in nursing homes. Disgusting. Doping them into premature senility makes them easier to stuff into cramped rooms and corridors that reek of urine with minimal staff. Ageism is real enough.

    I had a good friend in her eighties who needed a walker. Concerned she might fall again, her adult kids convinced her to move into a home. I visited her a week later and she was full of good spirits. Sharp as a tack.

    A month later she couldn’t talk. She was fearful and incoherent. Something rotten was going on. Probably after a doctor visited. It’s not about helping the residents but keeping them quiet and easy to subdue or abuse. Kind of like “treating” those our society has written off as hopelessly crazy. 😛