A Systematic Review of the Current Evidence from Randomised Controlled Trials on the Impact of Medication Optimisation or Pharmacological Interventions on Quantitative Measures of Cognitive Function in Geriatric Patients

Farhad Pazan, Mirko Petrovic, Antonio Cherubini, Alfonso J. Cruz-Jentoft, Michael Denkinger, Tischa J.M. van der Cammen, Jennifer M. Stevenson, Kinda Ibrahim, Chakravarthi Rajkumar, Marit Stordal Bakken, Peter Crome, Adalsteinn Guðmundsson, Wilma Knol, Birgitta M.G. Snijders, Denis O’Mahony, José Antonio Serra-Rexach, George Soulis, Rob J. van Marum, Gijsbertus Ziere, Alpana MairHeinrich Burkhardt, Agnieszka Neumann-Podczaska, Katarzyna Wieczorowska-Tobis, Marilia Andreia Fernandes, Heidi Gruner, Nathalie van der Velde, Martin Wehling*

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

Abstract

Background: Cognitive decline is common in older people. Numerous studies point to the detrimental impact of polypharmacy and inappropriate medication on older people’s cognitive function. Here we aim to systematically review evidence on the impact of medication optimisation and drug interventions on cognitive function in older adults. Methods: A systematic review was performed using MEDLINE and Web of Science on May 2021. Only randomised controlled trials (RCTs) addressing the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in older adults (aged > 65 years) were included. Single-drug interventions (e.g., on drugs for dementia) were excluded. The quality of the studies was assessed by using the Jadad score. Results: Thirteen studies met the inclusion criteria. In five studies a positive impact of the intervention on metric measures of cognitive function was observed. Only one study showed a significant improvement of cognitive function by medication optimisation. The remaining four positive studies tested methylphenidate, selective oestrogen receptor modulators, folic acid and antipsychotics. The mean Jadad score was low (2.7). Conclusion: This systematic review identified a small number of heterogenous RCTs investigating the impact of medication optimisation or pharmacological interventions on cognitive function. Five trials showed a positive impact on at least one aspect of cognitive function, with comprehensive medication optimisation not being more successful than focused drug interventions. More prospective trials are needed to specifically assess ways of limiting the negative impact of certain medication in particular and polypharmacy in general on cognitive function in older patients.

Original languageEnglish
Pages (from-to)863-874
Number of pages12
JournalDrugs and Aging
Volume39
Issue number11
DOIs
Publication statusPublished - Nov 2022

Bibliographical note

Funding:
Open Access funding enabled and organized by Projekt
DEAL.

Publisher Copyright:
© 2022, The Author(s).

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