SAN FRANCISCO – Community-dwelling elderly people were more likely to show cognitive decline over a 5-year period if they took medications that act on the central nervous system, especially with higher cumulative doses or with longer use.
In some patients, physicians may want to consider adjusting drug doses to lower the cumulative CNS medications dose while retaining the benefits of each medication, said Dr. Rollin M. Wright of the University of Pittsburgh, at the annual meeting of the Gerontological Society of America.
In a longitudinal cohort study, Dr. Wright and her colleagues examined 2,737 cognitively intact adults aged 70-79 years old at baseline and again 3 and 5 years later. All of the participants could walk a quarter of a mile and climb a flight of stairs, and were enrolled in the Health, Aging, and Body Composition study. The researchers gathered information about medication use from containers brought in by participants and assessed them for cognitive function using Teng's Modified Mini-Mental State Examination (3MS), they wrote in their poster.
Use of CNS-active medications including benzodiazepines, opioid receptor agonists, antipsychotics, or antidepressants was not linked to new-onset cognitive impairment (an 3MS score below 80) but was associated with new development of cognitive decline (a dip of 5 or more points on the 3MS).
Any use of the CNS-active medications was associated with a 36% increased risk of cognitive decline after adjustment for the effects of sociodemographic factors, health behavior, health status, and the indications for CNS medication use. Long-term use of CNS-active medications, defined as 2 or more years of use, was associated with a 39% increased risk of cognitive decline, compared with no use of the medications.
Participants on the highest cumulative doses of CNS-active medications had the greatest increased risk for cognitive decline. Those using the highest cumulative dose of more than three standardized daily doses had an 82% increased risk of cognitive decline, compared with nonusers.
CNS-active drug use rose from 14% of participants at baseline to 15% of 2,284 subjects at year 3, with 3% of the cohort using the highest doses, 11% reporting long-term use, and 20% showing cognitive decline.
At year 5, 17% of 1,907 subjects were using CNS-active medications, again with 3% on the highest doses and 11% citing long-term use. After excluding those showing cognitive decline at year 3, 14% of subjects at year 5 showed new cognitive decline. Indications for CNS-active medication use included sleep problems (11%), anxiety (34%), osteoarthritis (15%), cancer (18%), depression (4%), and bodily pain (40%). The study cohort was 53% female and 37% black, with a mean age of 74 years.
Dr. Wright has no ties with makers of the drugs used in the study. It was partially funded by the National Institute on Aging.