Skip to main content
SpringerLink
Log in

Charlson Comorbidity Index, inappropriate medication use and cognitive impairment

Bermuda Triangle

  • Original Article
  • Published:
Wiener klinische Wochenschrift Aims and scope Submit manuscript

Summary

Background

The aim is to evaluate the association between the Charlson Comorbidity Index (CCI), polypharmacy, inappropriate medication use and cognitive impairment in long-term care facility patients.

Methods

A cross-sectional study including 105 long-term care facility residents was performed. The Charlson Comorbidity Index (CCI) was used. Inappropriate drug use (IDU) was defined according to the STOPP (Screening Tool of Older People’s Prescriptions) criteria. Univariate analysis to identify variables associated with patient outcome related with cognitive impairment was investigated with χ2, Pearson correlation, Fisher exact, and Mann–Whitney U test where appropriate. For the multivariate analysis, the possible factors identified with univariate analysis were further entered into logistic regression analysis.

Results

A significant difference was found between gender, CCI and cognitive impairment (p = 0.038, p = 0.01). While every one point increment in the CCI increases the risk of cognitive impairment 3.1 fold (95% CI = 1.8–5.4, p < 0.001), hypertension increases the risk 12 fold (95% CI = 2.5–67.8, p = 0.002). While the correlation between Mini-Mental Status Examination (MMSE) score and polypharmacy is significant (p = 0.015), the correlation between MMSE and IDU was insignificant (p = 0.739). The association of urogenital system drugs and dementia was significant (p = 0.044).

Conclusions

Comorbidities, especially hypertension and old age, are risk factors for cognitive impairment. Polypharmacy correlates with MMSE and is considered a risk factor for cognitive impairment. Inappropriate medication use is high among long-term care facility residents. More studies on large cohorts are needed regarding optimal drug prescription and detection of specific drugs that may have an impact on cognitive performance.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Murphy SL, Xu J, Kochanek KD. Division of Vital Statistics. Deaths: final data for 2010. Natl Vital Stat Rep. 2013;61(4):1–117.

    PubMed  Google Scholar 

  2. Folstein M, Folstein S, McHugh P. Mini-mental state. A practical method for grading the cognitive state of patients for the clinician. J Psych Res. 1975;12:189–98.

    Article  CAS  Google Scholar 

  3. Schubert CC, Boustani M, Callahan CM, et al. Comorbidity profile of dementia patients in primary care: are they sicker? J Am Geriatr Soc. 2006;54:104–9.

    Article  PubMed  Google Scholar 

  4. Sanderson M, Wang J, Davis DR, et al. Co-morbidity associated with dementia. Am J Alzheimers Dis Other Demen. 2002;17:73–8.

    Article  PubMed  Google Scholar 

  5. Sarfati D, Tan L, Blakely T, et al. Comorbidity among patients with colon cancer in New Zealand. N Z Med J. 2011;124:76–88.

    PubMed  Google Scholar 

  6. Mnatzaganian G, Ryan P, Norman PE, et al. Accuracy of hospital morbidity data and the performance of comorbidity scores as predictors of mortality. J Clin Epidemiol. 2012;65:107–15.

    Article  PubMed  Google Scholar 

  7. Beers MH, Ouslander JG, Rollingher I, et al. Explicit criteria for determining inappropriate medication use in nursing home residents. Arch Intern Med. 1991;151:1825–32.

    Article  CAS  PubMed  Google Scholar 

  8. Guaraldo L, Cano FG, Damasceno GS, et al. Inappropriate medication use among the elderly: a systematic review of administrative databases. BMC Geriatr. 2011;11:79.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Gosch M, Wortz M, Nicholas JA, et al. Inappropriate prescribing as a predictor for long term mortality after hip fracture. Gerontology. 2014;60:114–22.

    Article  CAS  PubMed  Google Scholar 

  10. Klarin I, Wimo A, Fastbom J. The association of inappropriate drug use with hospitalisation and mortality a population based study of the very old. Drugs Aging. 2005;22:69–82.

    Article  PubMed  Google Scholar 

  11. Gallagher P, O’Mahony D. Screening tool of older persons’ potentially inappropriate prescriptions application to acutely ill elderly patients and comparison with beers’ criteria. Age Ageing. 2008;37:673–9.

    Article  PubMed  Google Scholar 

  12. Parsons C. Polypharmacy and inappropriate medication use in patients with dementia: an underresearched problem. Ther Adv Drug Saf. 2017;8:31–46.

    Article  PubMed  Google Scholar 

  13. Montastruc F, Gardette V, Cantet C, et al. Potentially inappropriate medication use among patients with Alzheimer disease in the REAL.FR cohort: be aware of atropinic and benzodiazepine drugs. Eur J Clin Pharmacol. 2013;69:1589–97.

    Article  PubMed  Google Scholar 

  14. Johnell K. Inappropriate drug use in people with cognitive impairment and dementia: a systematic review. Curr Clin Pharmacol. 2015;10:178–84.

    Article  PubMed  PubMed Central  Google Scholar 

  15. Sköldunger A, Fastbom J, Wimo A, et al. Impact of inappropriate drug use on hospitalizations, mortality, and costs in older persons and persons with dementia: findings from the SNAC study. Drugs Aging. 2015;32:671–8.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Wolf-Klein GP, Siverstone FA, Brod MS, et al. Are Alzheimer patients healthier? J Am Geriatr Soc. 1998;36:219–24.

    Article  Google Scholar 

  17. Sanderson M, Wang J, Davis DR, et al. Co-morbidity associated with dementia. Am J Alzheimers Dis Other Demen. 2002;17:73–8.

    Article  PubMed  Google Scholar 

  18. Corrada M, Hayden KM, Bullain SS, et al. Age of onset of hypertension and risk of dementia in the oldest-old: The 90+ study. Alzheimers Dement. 2017;13:103–10.

    Article  PubMed  Google Scholar 

  19. van Kooten F, Koudstaal PJ. Epidemiology of post-stroke dementia. Haemostasis. 1998;28:124–33.

    PubMed  Google Scholar 

  20. Pendlebury ST, Rothwell PM. Prevalence, incidence, and factors associated with pre-stroke and post-stroke dementia: a systematic review and meta-analysis. Lancet Neurol. 2009;8:1006–18.

    Article  PubMed  Google Scholar 

  21. Kivipelto M, Ngandu T, Fratiglioni L, et al. Obesity and vascular risk factors at midlife and the risk of dementia and Alzheimer disease. Arch Neurol. 2005;62:1556–60.

    Article  PubMed  Google Scholar 

  22. Schnaider Beeri M, Goldbourt U, Silverman JM, et al. Diabetes mellitus in midlife and the risk of dementia three decades later. Neurology. 2004;63:1902–7.

    Article  CAS  PubMed  Google Scholar 

  23. Tzourio C, Laurent S, Debette S. Is hypertension associated with an accelerated aging of the brain? Hypertension. 2014;63:894–903.

    Article  CAS  PubMed  Google Scholar 

  24. Skoog I, Lernfelt B, Landahl S, et al. 15-year longitudinal study of blood pressure and dementia. Lancet. 1996;347:1141–5.

    Article  CAS  PubMed  Google Scholar 

  25. Rouch L, Cestac P, Hanon O, et al. Antihypertensive drugs, prevention of cognitive decline and dementia: a systematic review of observational studies, randomized controlled trials and meta-analyses, with discussion of potential mechanisms. CNS Drugs. 2015;29:113–30.

    Article  CAS  PubMed  Google Scholar 

  26. Chang-Quan H, Hui W, Chao-Min W, et al. The association of antihypertensive medication use with risk of cognitive decline and dementia: a meta-analysis of longitudinal studies. Int J Clin Pract. 2011;65:1295–305.

    Article  CAS  PubMed  Google Scholar 

  27. Kennelly SP, Lawlor BA, Kenny RA. Blood pressure and the risk for dementia: a double edged sword. Ageing Res Rev. 2009;8:61–70.

    Article  PubMed  Google Scholar 

  28. Siennicki-Lantz A, Reinprecht F, Axelsson J, et al. Cerebral perfusion in the elderly with nocturnal blood pressure fall. Eur J Neurol. 2007;14:715–20.

    Article  CAS  PubMed  Google Scholar 

  29. Elmstahl S, Rosen I. Postural hypoten-sion and EEG variables predict cognitive decline:results from a 5-year follow-up of healthy elderly women. Dement Geriatr Cogn Disord. 1997;8:180–7.

    Article  CAS  PubMed  Google Scholar 

  30. Lopponen MK, Isoaho RE, Raiha IJ, et al. Undiagnosed diseases in patients with dementia-a potential target group for intervention. Dement Geriatr Cogn Disord. 2004;18:321–9.

    Article  PubMed  Google Scholar 

  31. Hajjar ER, Cafiero AC, Hanlon JT. Polypharmacy in elderly patients. Am J Geriatr Pharmacother. 2007;5:345–345.

    Article  PubMed  Google Scholar 

  32. Jyrkkä J, Enlund H, Lavikainen P, et al. Association of polypharmacy with nutritional status, functional ability and cognitive capacity over a three-year period in an elderly population. Pharmacoepidemiol Drug Saf. 2011;20:514–22.

    Article  PubMed  Google Scholar 

  33. Gallagher P, Barry P, O’Mahony D. Inappropriate prescribing in the elderly. J Clin Pharm Ther. 2007;32:113–21.

    Article  CAS  PubMed  Google Scholar 

  34. Sönnerstam E, Sjölander M, Gustafsson M. An evaluation of the prevalence of potentially inappropriate medications in older people with cognitive impairment living in Northern Sweden using the EU (7)-PIM list. Eur J Clin Pharmacol. 2017; https://doi.org/10.1007/s00228-017-2218-2.

    PubMed  PubMed Central  Google Scholar 

  35. Pasina L, Djade CD, Lucca U, et al. Association of Anticholinergic burden with cognitive and functional status in a cohort of hospitalized elderly: comparison of the Anticholinergic cognitive burden scale and Anticholinergic risk scale: results from the REPOSI study. Drugs Aging. 2013;30:103–12.

    Article  CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Faculty of Medicine, Department of Internal Medicine and Geriatrics, Yildirim Beyazit University, Lodumlu Mevkii, No:3 Bilkent, 06030, Ankara, Turkey

    Kamile Silay MD

  2. Department of Internal Medicine and Geriatrics, Ataturk Research and Training Hospital, Ankara, Turkey

    Ahmet Yalcin

  3. Department of Internal Medicine, Ataturk Research and Training Hospital, Ankara, Turkey

    Sema Akinci

  4. Faculty of Medicine, Department of Family Medicine, Yildirim Beyazit University, Ankara, Turkey

    Fatma Gul Gursoy

  5. Faculty of Medicine, Department of Internal Medicine and Oncology, Yildirim Beyazit University, Ankara, Turkey

    Didem Sener Dede

Authors
  1. Kamile Silay MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Ahmet Yalcin
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Sema Akinci
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Fatma Gul Gursoy
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Didem Sener Dede
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Kamile Silay MD.

Ethics declarations

Conflict of interest

K. Silay, A. Yalcin, S. Akinci, F.G. Gursoy, and D. Sener Dede declare that they have no competing interests.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Silay, K., Yalcin, A., Akinci, S. et al. Charlson Comorbidity Index, inappropriate medication use and cognitive impairment. Wien Klin Wochenschr 129, 799–804 (2017). https://doi.org/10.1007/s00508-017-1253-4

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00508-017-1253-4

Keywords

Search

Navigation