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Psychotropic medication use and cognition in institutionalized older adults with mild to moderate dementia

Published online by Cambridge University Press:  26 February 2009

Laura H. P. Eggermont ,
Kerst de Vries  and
Erik J. A. Scherder
Laura H. P. Eggermont*
Affiliation:
Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands
Kerst de Vries
Affiliation:
Nursing Home St. Jacob, Osiragroep, Amsterdam, The Netherlands
Erik J. A. Scherder
Affiliation:
Department of Clinical Neuropsychology, VU University, Amsterdam, The Netherlands Institute of Human Movement Sciences, University of Groningen, Groningen, The Netherlands
*
Correspondence should be addressed to: Dr Laura H. P. Eggermont, VU University, Department of Clinical Neuropsychology, Van der Boechorststraat 1, 1081 BT Amsterdam, The Netherlands. Phone: +31-20-598-8878, Fax: +31-20-598-8761. Email: [email protected].
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Abstract

Background: Most studies examining psychotropic medication use on cognition in older persons with dementia include measures of global cognitive function. The present study examined the relationship between different types of psychotropic medication and specific cognitive functions in older people with dementia.

Methods: Two hundred and six institutionalized older adults with dementia (180 women, mean age 85 years) were administered neuropsychological tests. Psychotropic medication use was extracted from their medical status and categorized as: sedatives, antidepressants and antipsychotics.

Results: Analysis of covariance revealed that psychotropic consumers, and particularly those who used antipsychotics, performed worse on neuropsychological tests of executive/attentional functioning than non-consumers. There were no differences between consumers of other classes of psychotropic drugs and non-consumers. The number of psychotropic drugs used was inversely related to executive/attentional functioning.

Conclusions: These findings show that in institutionalized older adults with dementia, specific impairment of cognitive function, i.e. executive/attentional impairments, are associated with antipsychotic medication use. Future longitudinal studies are recommended.

Keywords

antipsychotic agentsantidepressant agentshypnotics and sedativescognitive performancecognitive disordersnursing homeshomes for the aged
Type
Research Article
Information
International Psychogeriatrics , Volume 21 , Issue 2 , April 2009 , pp. 286 - 294
Copyright
Copyright © International Psychogeriatric Association 2009

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References

Alexopoulos, G. S., Abrams, R. C., Young, R. C. and Shamoian, C. A. (1988). Cornell Scale for Depression in Dementia. Biological Psychiatry, 23, 271–284.Google Scholar
Alexopoulos, G. S., Strein, J., Carpenter, D. and Dochtery, J. P. (2004). Expert Consensus Guideline Series: using antipsychotic agents in older patients. Journal of Clinical Psychiatry, 65, S4–104Google Scholar
Allard, J., Artero, S. and Ritchie, K. (2003). Consumption of psychotropic medication in the elderly: a re-evaluation of its effect on cognitive performance. International Journal of Geriatric Psychiatry, 18, 874–878.CrossRefGoogle ScholarPubMed
American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC: American Psychiatric Association.Google Scholar
Arrindell, W. A. and Ettema, J. H. (1986). SCL-90. Manual for a Multidimensional Psychopathology-indicator. [In Dutch: Handleiding bij een multidimensionele psychopathologie-indicator]. Lisse: Swets and Zeitlinger.Google Scholar
Ballard, C. and DART AD investigators (2008). A randomised, blinded, placebo-controlled trial in dementia patients continuing or stopping neuroleptics (the DART-AD trial). PLoS Medicine, 5, e76.CrossRefGoogle ScholarPubMed
Beinhoff, U., Hilbert, V., Bittner, D., Gron, G. and Riepe, M. W. (2005). Screening for cognitive impairment: a triage for outpatient care. Dementia and Geriatric Cognitive Disorders, 20, 278–285.Google Scholar
Bierman, E. J. et al. (2007). The effect of chronic benzodiazepine use on cognitive functioning in older persons: good, bad or indifferent? International Journal of Geriatric Psychiatry, 22, 1194–1200.Google Scholar
Brooks, J. O. and Hoblyn, J. C. (2007). Neurocognitive costs and benefits of psychotropic medications in older adults. Journal of Geriatric Psychiatry and Neurology, 20, 199–214.CrossRefGoogle ScholarPubMed
Burdick, D. J. et al. (2005). Predictors of functional impairment in residents of assisted-living facilities: the Maryland Assisted Living study. Journals of Gerontology: A Biological Sciences and Medical Sciences, 60, 258–264.Google Scholar
Caballero, J., Hitchcock, M., Scharre, D., Beversdorf, D. and Nahata, M. C. (2006). Cognitive effects of atypical antipsychotics in patients with Alzheimer's disease and comorbid psychiatric or behavioral problems: a retrospective study. Clinical Therapy, 28, 1695–1700.CrossRefGoogle ScholarPubMed
Cohen, J. (1992). Statistical Power Analysis for the Behavioral Sciences. Hillsdale, NJ: Lawrence Earlbaum Associates.Google Scholar
Cooper, J. W., Freeman, M. H., Cook, C. L. and Burfield, A. H. (2007). Assessment of psychotropic and psychoactive drug loads and falls in nursing facility residents. Consultant Pharmacist, 22, 483–489.CrossRefGoogle ScholarPubMed
Curran, H. V., Collins, R., Fletcher, S., Kee, S. C., Woods, B. and Iliffe, S. (2003). Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life. Psychological Medicine, 33, 1223–1237.CrossRefGoogle ScholarPubMed
Dealberto, M. J., McAvay, G. J., Seeman, T. and Berkman, L. (1997). Psychotropic drug use and cognitive decline among older men and women. International Journal of Geriatric Psychiatry, 12, 567–574.Google Scholar
De Deyn, P. P. et al. (2004). Olanzapine versus placebo in the treatment of psychosis with or without associated behavioral disturbances in patients with Alzheimer's disease. International Journal of Geriatric Psychiatry, 19, 115–126.CrossRefGoogle ScholarPubMed
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”: a practical method of grading cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Hannesdottir, K. and Morris, R. G. (2007). Primary and secondary anosognosia for memory impairment in patients with Alzheimer's disease. Cortex, 43, 1020–1030.CrossRefGoogle ScholarPubMed
Harrison, B. E. and Therrien, B. (2007). Effect of antipsychotic medication use on memory in patients with Alzheimer's disease: assessing the potential risk for accelerated recent autobiographical memory loss. Journal of Gerontological Nursing, 33, 11–20.Google Scholar
Hosia-Randell, H. and Pitkälä, K. (2005). Use of psychotropic drugs in elderly nursing home residents with and without dementia in Helsinki, Finland. Drugs and Aging, 22, 793–800.CrossRefGoogle ScholarPubMed
Kennedy, J. et al. (2005). Olanzapine does not enhance cognition in non-agitated and non-psychotic patients with mild to moderate Alzheimer's dementia. International Journal of Geriatric Psychiatry, 20, 1020–1027.CrossRefGoogle Scholar
Kok, R. M., Heeren, Th. J. and Van Hemert, A. M. (1993). De Geriatric Depression Scale. Tijdschrift voor Psychiatrie, 35, 416–421.Google Scholar
Kørner, A. et al. (2006). The Geriatric Depression Scale and the Cornell Scale for Depression in Dementia: a validity study. Nordic Journal of Psychiatry, 60, 360–364.CrossRefGoogle ScholarPubMed
Lakey, S. L., Gray, S. L., Sales, A. E., Sullivan, J. and Hedrick, S. C. (2006). Psychotropic use in community residential care facilities: a prospective cohort study. American Journal of Geriatric Pharmacotherapy, 4, 227–235.Google Scholar
Lindeboom, J. and Jonker, C. (1989). Amsterdam Dementia Screening Test, Manual [In Dutch: Amsterdamse Dementie-screeningtest, handleiding]. Lisse: Swets and Zeitlinger.Google Scholar
Livingston, G., Walker, A. E., Katona, C. L. and Cooper, C. (2007). Antipsychotics and cognitive decline in Alzheimer's disease: the LASER-Alzheimer's disease longitudinal study. Journal of Neurology, Neurosurgery and Psychiatry, 78, 25–29.CrossRefGoogle ScholarPubMed
Loewenstein, D. A., Rubert, M. P., Argüelles, T. and Duara, R. (1995). Neuropsychological test performance and prediction of functional capacities among Spanish-speaking and English-speaking patients with dementia. Archives of Clinical Neuropsychology, 10, 75–88.Google Scholar
McAndrews, M. P, Weissm, R. T., Sandor, P., Taylor, A., Carlen, P. L. and Shapiro, C. M. (2003). Cognitive effects of long-term benzodiazepine use in older adults. Human Psychopharmacology, 18, 51–57.CrossRefGoogle Scholar
Mossello, E. et al. (2008). Is antidepressant treatment associated with reduced cognitive decline in Alzheimer's disease? Dementia and Geriatric Cognitive Disorders, 25, 372–379.CrossRefGoogle ScholarPubMed
Palmer, K., Berger, A. K., Monastero, R., Winblad, B., Bäckman, L. and Fratiglioni, L. (2007). Predictors of progression from mild cognitive impairment to Alzheimer disease. Neurology, 68, 1596–1602.CrossRefGoogle ScholarPubMed
Rabins, P. V. et al. (2007). Practice Guideline for the Treatment of Patients with Alzheimer's Disease and Other Dementias. American Psychiatric Association. Available at: http://www.psychiatryonline.com/pracGuide/pracGuideTopic_3.aspx; last accessed June 2008.Google Scholar
Reekum, R. et al. (2002). A randomized, placebo-controlled trial of the discontinuation of long-term antipsychotics in dementia. International Psychogeriatrics, 14, 197–210.CrossRefGoogle ScholarPubMed
Ruths, S., Straand, J. and Nygaard, H. A. (2001). Psychotropic drug use in nursing homes: diagnostic indications and variations between institutions. European Journal of Clinical Pharmacology, 57, 523–528.Google Scholar
Ruths, S., Straand, J., Nygaard, H. A. and Aarsland, D. (2008). Stopping antipsychotic drug therapy in demented nursing home patients: a randomized, placebo-controlled study – The Bergen District Nursing Home Study (BEDNURS). International Journal of Geriatric Psychiatry, 23, 889–895.CrossRefGoogle Scholar
Schäufele, M., Bickel, H. and Weyerer, S. (2002). Which factors influence cognitive decline in older adults suffering from dementing disorders? International Journal of Geriatric Psychiatry, 17, 1055–1063.Google Scholar
Schneider, L. S., Dagerman, K. and Insel, P. S. (2006a). Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. American Journal of Geriatric Psychiatry, 14, 191–210.CrossRefGoogle ScholarPubMed
Schneider, L. S. et al. . CATIE-AD Study Group (2006b). Effectiveness of atypical antipsychotic drugs in patients with Alzheimer's disease. New England Journal of Medicine, 355, 1525–1538.Google Scholar
Sheridan, P. L. and Hausdorff, J. M. (2007). The role of higher-level cognitive function in gait: executive dysfunction contributes to fall risk in Alzheimer's disease. Dementia and Geriatric Cognitive Disorders, 24, 125–137.Google Scholar
Snijders, J. T. and Verhage, F. (1983). Groninger Intelligentie Test. Lisse: Swets and Zeitlinger.Google Scholar
Snowdon, J., Day, S. and Baker, W. (2006). Current use of psychotropic medication in nursing homes. International Psychogeriatrics, 18, 241–250.CrossRefGoogle ScholarPubMed
Steffens, D. C. (2008). Separating mood disturbance from mild cognitive impairment in geriatric depression. International Review of Psychiatry, 20, 374–381.CrossRefGoogle ScholarPubMed
Teng, E. L. and Manly, J. J. (2005). Neuropsychological testing: helpful or harmful? Alzheimer Disease and Associated Disorders, 19, 267–271.CrossRefGoogle ScholarPubMed
Tsoi, T., Baillon, S. and Lindesay, J. (2008). Early frontal executive impairment as a predictor of subsequent behavior disturbance in dementia. American Journal of Geriatric Psychiatry, 16, 102–108.CrossRefGoogle ScholarPubMed
Tucker, M. and Hosford, I. (2008). Use of psychotropic medicines in residential care facilities for older people in Hawke's Bay, New Zealand. New Zealand Medical Journal, 121, 18–25.Google Scholar
Valiyeva, E., Herrmann, N., Rochon, P. A., Gill, S. S. and Anderson, G. M. (2008). Effect of regulatory warnings on antipsychotic prescription rates among elderly patients with dementia: a population-based time-series analysis. Canadian Medical Association Journal, 179, 438–446.CrossRefGoogle ScholarPubMed
Verhage, F. (1964). Intelligence and Age: Research on Dutch People aged Twelve to Seventy-seven Years Old. [In Dutch: Intelligentie en leeftijd: onderzoek bij Nederlanders van twaalf tot zevenenzeventig jaar]. Assen: Van Gorcum.Google Scholar
Wadsworth, E. J., Moss, S. C., Simpson, S. A. and Smith, A. P. (2005). Psychotropic medication use and accidents, injuries and cognitive failures. Human Psychopharmacology, 20, 391–400.Google Scholar
Wechsler, D. (1987). Wechsler Memory Scale – Revised. New York: The Psychological Corporation.Google Scholar
Wilson, B., Cockburn, J. and Baddeley, A. (1987). The Rivermead Behavioural Memory Test. Titchfield: Thames Valley Test Company.Google Scholar