Risk of Cognitive Decline Associated With Paroxetine Use in Elderly Nursing Home Patients With Depression

Bali, Vishal; Chatterjee, Satabdi; Johnson, Michael L.; Chen, Hua; Carnahan, Ryan M.; Aparasu, Rajender R.

doi:10.1177/1533317516673463

Cited by 11 publications

(7 citation statements)

References 39 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…In addition, 14 predictors had inconclusive findings, whereby no more than 50% of the studies in which they were evaluated identified them as a risk factor, protective factor, or not associated with cognitive decline. Inconclusive predictors include sensory impairment [ 7 , 8 , 22 , 31 ], diabetes [ 7 , 15 , 32 ], depression with dementia [ 13 , 14 ], incontinence [ 7 , 8 ], stroke [ 7 , 15 ], physical restraints [ 7 , 21 , 33 ], aggression [ 7 , 34 ], falls [ 7 , 8 ], malnutrition [ 8 , 35 ], antipsychotic use [ 7 , 8 , 15 , 21 , 33 , 36 ], antidepressant use [ 7 , 15 , 36 , 37 ], older age [ 7 , 8 , 10 , 15 , 18 , 38 ], female gender [ 7 , 10 , 15 ], and being a racial minority [ 7 , 15 ].…”

Section: Resultsmentioning

confidence: 99%

Identifying predictors of cognitive decline in long-term care: a scoping review

Arora,

Milani,

Tanuseputro

et al. 2023

BMC Geriatr

View full text Add to dashboard Cite

Background Cognitive impairment can cause social, emotional, and financial burdens on individuals, caregivers, and healthcare providers. This is especially important in settings such as long-term care (LTC) homes which largely consist of vulnerable older adults. Thus, the objective of this study is to review and summarize current research examining risk factors of cognitive decline in older adults within LTC. Methods This scoping review includes primary observational research studies assessing within-person change in cognition over time in LTC or equivalent settings in high resource countries. A mean participant age of ≥ 65 years was required. Searches were conducted in Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PyscInfo on June 27th, 2022 and included articles published during or after the year 2000. Title, abstract, and full-text screening was performed by two independent reviewers using Covidence. Specific predictors along with their associated relation with cognitive decline were extracted by a team of reviewers into a spreadsheet. Results Thirty-eight studies were included in this review. The mean sample size was 14 620. Eighty-seven unique predictors were examined in relation to cognitive decline. Dementia was the most studied predictor (examined by 9 of 38 studies), and the most conclusive, with eight of those studies identifying it as a risk factor for cognitive decline. Other predictors that were identified as risk factors included arterial stiffness (identified by 2 of 2 studies), physical frailty (2 of 2 studies), sub-syndromal delirium (2 of 2 studies), and undergoing the first wave of COVID-19 lockdowns (2 of 2 studies). ADL independence was the most conclusive protective factor (3 of 4 studies), followed by social engagement (2 of 3 studies). Many remaining predictors showed no association and/or conflicting results. Conclusions Dementia was the most common risk factor, while ADL independence was the most common protective factor associated with cognitive decline in LTC residents. This information can be used to stratify residents by risk severity and provide better personalized care for older adults through the targeted management of cognitive decline.

show abstract

Section: Resultsmentioning

confidence: 99%

Identifying predictors of cognitive decline in long-term care: a scoping review

Arora,

Milani,

Tanuseputro

et al. 2023

BMC Geriatr

View full text Add to dashboard Cite

show abstract

“…However, it has strong anticholinergic and sedative properties, which can lead to negative effects on cognition. Anticholinergic medications such as paroxetine are often considered potentially inappropriate for elderly patients with dementia and cognitive impairment [ 47 ]. The use of paroxetine and other SSRIs has substantially increased during the last decades [ 48 ], but studies show that patients often receive suboptimal treatment because of the concomitant use of anticholinergic drugs, excessively high or low daily dosages, short-duration therapy, or inadequate follow-up [ 49 , 50 ].…”

Section: Discussionmentioning

confidence: 99%

Potentially Inappropriate Prescribing among Elderly Outpatients: Evaluation of Temporal Trends 2012–2018 in Piedmont, Italy

Galimberti

Casula

Scotti

et al. 2022

IJERPH

View full text Add to dashboard Cite

Pharmacological intervention is one of the cornerstones in the treatment and prevention of disease in modern healthcare. However, a large number of drugs are often prescribed and used inappropriately, especially in elderly patients. We aimed at investigating the annual prevalence of potentially inappropriate prescriptions (PIPs) among older outpatients using administrative healthcare databases of the Piedmont Region (Italy) over a seven-year period (2012–2018). We included all Piedmont outpatients aged 65 years or older with at least one drug prescription per year. Polypharmacy and the prevalence of PIPs according to the ERD list explicit tool were measured on an annual basis. A range between 976,398 (in 2012) and 1,066,389 (in 2018) elderly were evaluated. Among them, the number of subjects with at least one PIP decreased from 418,537 in 2012 to 339,764 in 2018; the prevalence significantly reduced by ~25% over the study period. The stratified analyses by age groups and sex also confirmed the downward trend and identified several differences in the most prevalent inappropriately prescribed drugs. Overall, despite a reduction in PIP prevalence, one out of three older outpatients was still exposed to inappropriateness, highlighting the extensive need for intervention to improve prescribing.

show abstract

“…Several studies also summarized the relationship between antidepressant use and cognitive decline using longitudinal rates of change (as is in the case in linear mixed model approaches) [19,20] or odds ratios (provided by logistic regression) [17]. Recent studies that have used the linear mixed modeling approach failed to find evidence for a significant association between antidepressant use and cognitive decline [19][20][21]. In these models, study participants are assigned a cognitive score (usually based on a battery of cognitive tests) and the primary comparison is made between antidepressant users and non-users with respect to the rate of change on this score.…”

Section: Discussionmentioning

confidence: 99%

“…Some studies have found an inverse relationship-that antidepressant use may decrease the risk of developing dementia [15][16]. In some cases researchers have differentiated among classes of antidepressants, such as tricyclic antidepressants (TCAs), monoamine oxidase inhibitors (MAOIs), selective serotonin reuptake inhibitors (SSRIs), and serotonin and noradrenaline reuptake inhibitors (SNRIs) [17][18][19][20][21][22][23][24]. Conclusive evidence on whether antidepressant use influences cognitive function is still lacking.…”

Section: Introductionmentioning

confidence: 99%

Estimating associations between antidepressant use and incident mild cognitive impairment in older adults with depression

et al. 2020

View full text Add to dashboard Cite

IntroductionPrevious studies have provided equivocal evidence of antidepressant use on subsequent cognitive impairment; this could be due to inconsistent modeling approaches. Our goals are methodological and clinical. We evaluate the impact of statistical modeling approaches on the associations between antidepressant use and risk of Mild Cognitive Impairment (MCI) in older adults with depression. Methods716 participants were enrolled. Our primary analysis employed a time-dependent Cox proportional hazards model. We also implemented two fixed-covariate proportional hazards models-one based on having ever used antidepressants during follow-up, and the other restricted to baseline use only. ResultsTreating antidepressant use as a time-varying covariate, we found no significant association with incident MCI (HR = 0.92, 95% CI: 0.70, 1.20). In contrast, when antidepressant use was treated as a fixed covariate, we observed a significant association between having ever used antidepressants and lower risk of MCI (HR = 0.40, 95% CI: 0.28, 0.56). However, in the baseline-use only model, the association was non-significant (HR = 0.84, 95% CI: 0.60, 1.17).

show abstract

Risk of Cognitive Decline Associated With Paroxetine Use in Elderly Nursing Home Patients With Depression

Abstract: There was no differential effect of paroxetine on cognition when compared to other SSRIs.

Cited by 11 publications

References 39 publications

Identifying predictors of cognitive decline in long-term care: a scoping review

Identifying predictors of cognitive decline in long-term care: a scoping review

Potentially Inappropriate Prescribing among Elderly Outpatients: Evaluation of Temporal Trends 2012–2018 in Piedmont, Italy

Estimating associations between antidepressant use and incident mild cognitive impairment in older adults with depression

Contact Info

Product

Resources

About