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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

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
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

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.

1170-229X
863-874
Pazan, Farhad
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Petrovic, Mirko
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Cherubini, Antonio
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Cruz-Jentoft, Alfonso
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Denkinger, Michael D.
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Van der Cammen, Tischa
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Stevenson, Jennifer M.
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Ibrahim, Kinda
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Rajkumar, Chakravarthi
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Stordal Bakken, Marit
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Crome, Peter
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Knol, Wilma
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Snijders, Birgitta M. G.
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O’Mahony, Denis
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Soulis, George
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van Marum, Rob J.
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Ziere, Gijsbertus
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Mair, Alpana
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Burkhardt, Heinrich
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Neumann‑Podczaska, Agnieszka
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Wieczorowska‑Tobis, Katarzyna
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Fernandes, Marilia Andreia
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Gruner, Heidi
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van der Velde, Nathalie
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Wehling, Martin
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Pazan, Farhad
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Petrovic, Mirko
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Cherubini, Antonio
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Cruz-Jentoft, Alfonso
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Denkinger, Michael D.
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Van der Cammen, Tischa
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Stevenson, Jennifer M.
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Rajkumar, Chakravarthi
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Stordal Bakken, Marit
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Crome, Peter
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Guðmundsson, Adalsteinn
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Knol, Wilma
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Snijders, Birgitta M. G.
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Soulis, George
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van Marum, Rob J.
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Ziere, Gijsbertus
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Mair, Alpana
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Fernandes, Marilia Andreia
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Gruner, Heidi
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van der Velde, Nathalie
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Wehling, Martin
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Pazan, Farhad, Petrovic, Mirko, Cherubini, Antonio, Cruz-Jentoft, Alfonso, Denkinger, Michael D., Van der Cammen, Tischa, Stevenson, Jennifer M., Ibrahim, Kinda, Rajkumar, Chakravarthi, Stordal Bakken, Marit, Crome, Peter, Guðmundsson, Adalsteinn, Knol, Wilma, Snijders, Birgitta M. G., O’Mahony, Denis, Serra‑Rexach, José Antonio, Soulis, George, van Marum, Rob J., Ziere, Gijsbertus, Mair, Alpana, Burkhardt, Heinrich, Neumann‑Podczaska, Agnieszka, Wieczorowska‑Tobis, Katarzyna, Fernandes, Marilia Andreia, Gruner, Heidi, van der Velde, Nathalie and Wehling, Martin (2022) 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. Drugs & Aging, 39 (11), 863-874. (doi:10.1007/s40266-022-00980-9).

Record type: 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.

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Accepted/In Press date: 19 September 2022
e-pub ahead of print date: 26 October 2022
Published date: 1 November 2022
Additional Information: © 2022. The Author(s).

Identifiers

Local EPrints ID: 472255
URI: http://eprints.soton.ac.uk/id/eprint/472255
ISSN: 1170-229X
PURE UUID: 65bec02c-ad02-49c2-8a41-ca8f147eb242
ORCID for Kinda Ibrahim: ORCID iD orcid.org/0000-0001-5709-3867

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Date deposited: 30 Nov 2022 17:38
Last modified: 01 Dec 2022 02:45

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Contributors

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

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