Abstract
Cognitive impairment significantly influences pharmacotherapy as a major barrier for successful adherence. This is outlined in more detail in chapter “Adherence to Pharmacotherapy in the Elderly.” Cognitive function compromises not only adherence and management of pharmacotherapy but also cognitive function itself, which is an important target for pharmacotherapy to slow further deterioration in case of dementia or delirium (see chapters “Dementia” and “Central Nervous System (CNS) Medications and Delirium”). Unfortunately, drugs may also cause harm by inducing unintended cerebral symptoms such as disorientation, delusion and hallucination (delirium), dizziness, adynamia, and forgetfulness. These adverse drug reactions are often missed or misinterpreted and hereby represent a main factor of inadequate prescribing cascades (Fig. 1).
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
References
American Psychiatric Association (1994) Diagnostic and statistical manual of mental disorders, 4th edn. American Psychiatric Association, Washington, DC
Burke AD, Tariot PN (2009) Atypical antipsychotics in the elderly: a review of therapeutic trends and clinical outcomes. Expert Opin Pharmacother 10:2407–2414
Caligiuri MP, Lacro JP, Rockwell E, McAdams LA, Jeste DV (1997) Incidence and risk factors for severe tardive dyskinesia in older patients. Br J Psychiatry 171:148–153
Cole MG (2004) Delirium in elderly patients. Am J Geriatr Psychiatry 12:7–21
Gill SS, Rochon PA, Herrmann N et al (2005) Atypical antipsychotic drugs and risk of ischaemic stroke: population based retrospective cohort study. BMJ 330(7489):445
Han L, McCusker J, Cole M, Abrahamowicz M, Primeau F, Elie M (2001) Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients. Arch Intern Med 161:1099–1105
Inouye SK, van Dyck CH, Alessi CA, Balkin S, Siegal AP, Horwitz RI (1990) Clarifying confusion: the confusion assessment method. A new method for detection of delirium. Ann Intern Med 113:941–948
Kindermann SS, Dolder CR, Bailey A, Katz IR, Jeste DV (2002) Pharmacological treatment of psychosis and agitation in elderly patients with dementia: four decades of experience. Drugs Aging 19:257–276
Lewis LM, Miller DK, Morley JE, Nork MJ, Lasater LC (1995) Unrecognized delirium in geriatric patients. Am J Emerg Med 13:142–145
Madhusoodanan S, Bogunovic OJ (2004) Safety of benzodiazepines in the geriatric population. Expert Opin Drug Saf 3:485–493
McCusker J, Cole M, Bellavance F, Primeau F (1998) Reliability and validity of a new measure of severity of delirium. Int Psychogeriatr 10:421–433
Overshott R, Karim S, Burns A (2008) Cholinesterase inhibitors for delirium. Cochrane Database Syst Rev (1):CD005317
Ray WA, Chung CP, Murray KT, Hall K, Stein CM (2009) Atypical antipsychotic drugs and the risk of sudden cardiac death. N Engl J Med 360:225–235
Rummans TA, Evans JM, Krahn LE, Fleming KC (1995) Delirium in elderly patients: evaluation and management. Mayo Clin Proc 70:989–998
Schneider LS, Dagerman K, Insel PS (2006) Efficacy and adverse effects of atypical antipsychotics for dementia: meta-analysis of randomized, placebo-controlled trials. Am J Geriatr Psychiatry 14:191–210
Stewart SA (2005) The effects of benzodiazepines on cognition. J Clin Psychiatry 66(Suppl 2):9–13
Tune L, Carr S, Hoag E, Cooper T (1992) Anticholinergic effects of drugs commonly prescribed for the elderly: potential means for assessing risk of delirium. Am J Psychiatry 149:1393–1394
Wengel SP, Burke WJ, Roccaforte WH (1999) Donepezil for postoperative delirium associated with Alzheimer’s disease. J Am Geriatr Soc 47:379–380
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2013 Springer-Verlag Wien
About this chapter
Cite this chapter
Burkhardt, H. (2013). Pharmacotherapy and Special Aspects of Cognitive Disorders in the Elderly. In: Wehling, M. (eds) Drug Therapy for the Elderly. Springer, Vienna. https://doi.org/10.1007/978-3-7091-0912-0_21
Download citation
DOI: https://doi.org/10.1007/978-3-7091-0912-0_21
Published:
Publisher Name: Springer, Vienna
Print ISBN: 978-3-7091-0911-3
Online ISBN: 978-3-7091-0912-0
eBook Packages: MedicineMedicine (R0)