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 Pazan¹, Mirko Petrovic², Antonio Cherubini³, Alfonso J Cruz-Jentoft⁴, Michael Denkinger⁵, Tischa J M van der Cammen⁶, Jennifer M Stevenson^{7

8}, Kinda Ibrahim⁹, Chakravarthi Rajkumar¹⁰, Marit Stordal Bakken¹¹, Peter Crome¹², Adalsteinn Guðmundsson¹³, Wilma Knol¹⁴, Birgitta M G Snijders¹⁵, Denis O'Mahony¹⁶, José Antonio Serra-Rexach^{17

18

19

20}, George Soulis²¹, Rob J van Marum²², Gijsbertus Ziere^{23

24}, Alpana Mair²⁵, Heinrich Burkhardt²⁶, Agnieszka Neumann-Podczaska²⁷, Katarzyna Wieczorowska-Tobis^{27

28}, Marilia Andreia Fernandes²⁹, Heidi Gruner²⁹, Nathalie van der Velde^{30

31}, Martin Wehling³²

Affiliations

¹ Clinical Pharmacology Mannheim, Faculty of Medicine Mannheim, Ruprecht-Karls-University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
² Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.
³ Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy.
⁴ Servicio de Geriatría. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
⁵ Institute for Geriatric Research, University of Ulm and Geriatric Center Ulm, Agaplesion Bethesda Hospital, Ulm, Germany.
⁶ Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands.
⁷ Institute of Pharmaceutical Science, King's College London, London, UK.
⁸ Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁹ Academic Geriatric Medicine, Faculty of Medicine, Southampton University, Southampton, UK.
¹⁰ Geriatric & Stroke Medicine, Brighton and Sussex Medical School, Brighton, UK.
¹¹ Department of Clinical Science, University of Bergen, Bergen, Norway.
¹² Keele University, Newcastle under Lyme, UK.
¹³ University of Iceland, Geriatrics K4, Landspítali University, Reykjavík, Iceland.
¹⁴ Geriatrics, Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁵ Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁶ Department of Medicine, University College Cork, Cork University Hospital, Cork, Ireland.
¹⁷ Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
¹⁸ Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
¹⁹ Consorcio de Investigación Biomédica en Red: Fragilidad y Envejecimiento Saludable, CIBERFES, Madrid, Spain.
²⁰ Medicine Department, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
²¹ Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece.
²² Department of General Medicine and Geriatric Medicine, Free University, Amsterdam, The Netherlands.
²³ Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
²⁴ Department of Geriatric Medicine, Maasstad Hospital, Rotterdam, The Netherlands.
²⁵ Effective Prescribing and Therapeutics, Scottish Government, Edinburgh, EH1 3DG, UK.
²⁶ IV. Medical Department, Geriatrics, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
²⁷ Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland.
²⁸ Palliative Medicine Unit, University Hospital of Lord's Transfiguration, Poznan, Poland.
²⁹ Department of Internal Medicine/ Geriatric Clinic, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
³⁰ Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
³¹ Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
³² Clinical Pharmacology Mannheim, Faculty of Medicine Mannheim, Ruprecht-Karls-University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. martin.wehling@medma.uni-heidelberg.de.

PMID: 36284081
PMCID: PMC9626423
DOI: 10.1007/s40266-022-00980-9

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 et al. Drugs Aging. 2022 Nov.

. 2022 Nov;39(11):863-874.

doi: 10.1007/s40266-022-00980-9. Epub 2022 Oct 26.

Authors

Affiliations

¹ Clinical Pharmacology Mannheim, Faculty of Medicine Mannheim, Ruprecht-Karls-University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
² Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.
³ Geriatria, Accettazione geriatrica e Centro di ricerca per l'invecchiamento, IRCCS INRCA, Ancona, Italy.
⁴ Servicio de Geriatría. Hospital Universitario Ramón y Cajal (IRYCIS), Madrid, Spain.
⁵ Institute for Geriatric Research, University of Ulm and Geriatric Center Ulm, Agaplesion Bethesda Hospital, Ulm, Germany.
⁶ Faculty of Industrial Design Engineering, Delft University of Technology, Delft, Netherlands.
⁷ Institute of Pharmaceutical Science, King's College London, London, UK.
⁸ Pharmacy Department, Guy's and St Thomas' NHS Foundation Trust, London, UK.
⁹ Academic Geriatric Medicine, Faculty of Medicine, Southampton University, Southampton, UK.
¹⁰ Geriatric & Stroke Medicine, Brighton and Sussex Medical School, Brighton, UK.
¹¹ Department of Clinical Science, University of Bergen, Bergen, Norway.
¹² Keele University, Newcastle under Lyme, UK.
¹³ University of Iceland, Geriatrics K4, Landspítali University, Reykjavík, Iceland.
¹⁴ Geriatrics, Department of Geriatric Medicine and Expertise Centre Pharmacotherapy in Old Persons, University Medical Center Utrecht, Utrecht University, Utrecht, The Netherlands.
¹⁵ Department of Geriatric Medicine, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁶ Department of Medicine, University College Cork, Cork University Hospital, Cork, Ireland.
¹⁷ Geriatric Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
¹⁸ Instituto de Investigación Sanitaria Gregorio Marañón, Madrid, Spain.
¹⁹ Consorcio de Investigación Biomédica en Red: Fragilidad y Envejecimiento Saludable, CIBERFES, Madrid, Spain.
²⁰ Medicine Department, Facultad de Medicina, Universidad Complutense de Madrid, Madrid, Spain.
²¹ Outpatient Geriatric Assessment Unit, Henry Dunant Hospital Center, Athens, Greece.
²² Department of General Medicine and Geriatric Medicine, Free University, Amsterdam, The Netherlands.
²³ Section of Geriatric Medicine, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
²⁴ Department of Geriatric Medicine, Maasstad Hospital, Rotterdam, The Netherlands.
²⁵ Effective Prescribing and Therapeutics, Scottish Government, Edinburgh, EH1 3DG, UK.
²⁶ IV. Medical Department, Geriatrics, University Hospital Mannheim, Heidelberg University, Mannheim, Germany.
²⁷ Department of Palliative Medicine, Poznan University of Medical Sciences, Poznan, Poland.
²⁸ Palliative Medicine Unit, University Hospital of Lord's Transfiguration, Poznan, Poland.
²⁹ Department of Internal Medicine/ Geriatric Clinic, Hospital Curry Cabral, Centro Hospitalar Universitário de Lisboa Central, Lisbon, Portugal.
³⁰ Department of Internal Medicine, Section of Geriatric Medicine, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
³¹ Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
³² Clinical Pharmacology Mannheim, Faculty of Medicine Mannheim, Ruprecht-Karls-University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany. martin.wehling@medma.uni-heidelberg.de.

PMID: 36284081
PMCID: PMC9626423
DOI: 10.1007/s40266-022-00980-9

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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Conflict of interest statement

MW was employed by AstraZeneca R&D, Mölndal, as director of discovery medicine (translational medicine) from 2003 to 2006, while on sabbatical leave from his professorship at the University of Heidelberg. Since returning to this position in January 2007, he has received lecturing and consulting fees from Bristol Myers, Bayer, Boehringer-Ingelheim, LEO, Mundipharma, Novartis, Pfizer, Polyphor, Helsinn, Allergan, Allecra, Novo-Nordisk, Heel, AstraZeneca, Roche, Santhera, Sanofi-Aventis, Shire, Berlin-Chemie und Daichii-Sankyo. FP, MP, KI, GZ, ANP, KWT, BS, AG, WK, CR, AC, HB, MD, DOM, HG, MAF, TJMC, PC, JS, AM, ACJ, NVV, MSB, JASR, GS and RM have no COIs to declare.

Figures

**Fig. 1**
Flow diagram of randomised controlled trials (RCTs) on the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in geriatric patients (Preferred Reporting Items for Systematic Reviews and Meta-Analyses [PRISMA])

See this image and copyright information in PMC

References

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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

Affiliations

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

Authors

Affiliations

Abstract

Conflict of interest statement

Figures

References

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Substances

LinkOut - more resources

Full Text Sources

Medical

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