Utilization of Medications With Cognitive Impairment Side Effects and the Implications for Older Adults’ Cognitive Function

Abstract

Objectives: Many medications have cognitive impairment, memory loss, amnesia, or dementia as side effects (“cognitive side effects” hereafter), but little is known about trends in the prevalence of these medications or their implications for population-level cognitive impairment. Method: We use data from the National Health and Nutrition Examination Survey (1999–2016) to describe trends in the use of medications with cognitive side effects among adults aged 60+ ( N = 16,937) and their implications for cognitive functioning (measured using word learning and recall, animal fluency, and digit symbol substitution assessments). Results: Between 1999 to 2000 and 2015 to 2016, the prevalence of older adults taking one, two, and at least three medications with cognitive side effects increased by 10.2%, 57.3%, and 298.7%, respectively. Compared to non-users, respondents who simultaneously used three or more medications with cognitive side effects scored 0.22 to 0.27 standard deviations lower in word learning and recall ( p = .02), digit symbol substitution ( p < .01), and the average standardized score of the three assessments ( p < .001). Limitation: Dosage of medications associated with cognitive side effects was not measured. Discussion: Concurrent use of medications with cognitive side effects among older adults has increased dramatically over the past two decades. The use of such medications is associated with cognitive impairment and may explain for disparities in cognitive function across subgroups. These findings highlight the need for cognitive screenings among patients who consume medications with cognitive side effects. They also highlight the synergic effects of polypharmacy and potential drug-drug interactions that result in cognitive deficits.

Cognitive complaints in age-related chronic conditions: A systematic review

“…Furthermore, medications commonly used to treat many chronic conditions can have cognitive side effects, particularly in older adults [ 65 , 66 ]. The prevalence of taking multiple medications has dramatically increased in the past two decades: an over 50% increase in older adults taking two, and an almost 300% increase in those taking three or more [ 67 ]. Future research on SCD, multimorbidity, and AD risk should consider the potential role of medications and polypharmacy on cognitive outcomes.…”

Trends in the use of medications with insomnia side effects and the implications for insomnia among US adults

“…Prior studies have documented the negative health consequences of polypharmacy, including adverse drug events, drug–drug interactions, medication non‐adherence, falls and cognitive impairment (Fulton & Riley Allen, 2005). Polypharmacy may present unique risks for medication side effects, amplifying the effects of each of the medications in a set (Do & Schnittker, 2020). Further, polypharmacy may increase the risk of drug–drug interactions that may result in insomnia symptoms.…”

“…Qato, Ozenberger, and Olfson (2018) used a nationally representative sample of US adults from the National Health and Nutrition Examination Survey (NHANES) and found that respondents who simultaneously consumed at least three medications with depression side effects were 10.7 percentage points more likely to report depressive symptoms compared to non‐users. Using the same survey, Do and Schnittker (2020) reported that the concurrent use of three or more medications with cognitive impairment side effects among US older adults increased 3‐fold between 1999 and 2016. In addition, individuals who used three or more such medications experienced increased risks of cognitive deficits compared to non‐users.…”

“…Previous studies have independently established the accuracy and reliability of Micromedex's coverage of the FDA’s black box warnings and drug–drug interactions (Barrons, 2004; Cheng, Guglielmo, Maselli, & Auerbach, 2010). In addition, a growing number of studies have used Micromedex to identify medication side effects and to assess the association between medication side effects and the health of the population (Do & Schnittker, 2020; Qato et al., 2018; Schnittker & Do 2020). This study identified 239 medications with insomnia side effects.…”

“…Multivariate ordinary least squared and logistic models were used to assess the association between insomnia‐related outcomes and the use of medications with insomnia side effects. To address the issue of unobserved heterogeneity in health and other factors, all analyses controlled for the use of medications without insomnia side effects (Do & Schnittker, 2020; Qato et al., 2018; Schnittker & Do, 2020). If the relationship between medications with insomnia side effects and insomnia was driven by unobserved heterogeneity in health and other factors, the relationship between medications without known insomnia side effects and insomnia should be equally significant as that between medications with insomnia side effects and insomnia.…”