Influence of central nervous system-acting drugs on results of cognitive testing in geriatric inpatients

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Abstract

Introduction

Growing evidence shows a high correlation between extensive use of central nervous system-acting drugs (CNSADs) in elderly patients and adverse drug reactions (ADRs) such as falls, fractures, and mortality.

Research question

Are results of cognitive testing with the Mini Mental Status Examination (MMSE) influenced by use of CNSADs?

Setting

Geriatric inpatient service for acute, subacute, and rehabilitation care.

Methods

Secondary combined analysis of two prospective, single-center study cohorts (PROPSYC, 2011 and AGE OUT, 2012) with identical procedure for the MMSE at a tertiary hospital.

Results

Overall, 395 patients were included, 144 male (M) and 251 female (F). Mean age was 80.0 ± 8.4 years (M 76.7 ± 9.1, F 81.9 ± 7.3, p = 0.0000). Mean MMSE points were 22.9 ± 4.8 (M 23.2 ± 4.6, F 22.6 ± 5.0, p = 0.211). In total, 258 patients (65.3 %) used drugs with potential adverse cognitive properties. Analgesics with central activity were given to 117 of 395 patients (29.6 %). Low-potency opioids (tramadol hydrochloride, tilidine) were identified in 60 patients and high-potency opioids in 57 patients. Antidepressants were used in 66 patients, benzodiazepines in 26, and hypnotics in 11, while 38 patients received other CNSADs. We only found significant correlations with the results of cognitive testing for sedatives (diazepam and oxazepam, Pearson’s r − 0.79, p = 0.05), but not for lorazepam.

Conclusion

Our analysis shows an influence of sedatives (diazepam and oxazepam, but not lorazepam) on cognitive testing with the MMSE in users of CNSADs.

Keywords

Cognition Central nervous system-acting drugs (CNSADs) MMSE Elderly patients Adverse drug reactions (ADRs) 

Einfluss von zentralnervös wirkenden Medikamenten auf die kognitive Testung von geriatrischen Patienten im Krankenhaus

Zusammenfassung

Hintergrund

Eine zunehmende Evidenz zeigt bei älteren Menschen eine häufige Anwendung von Medikamenten mit zentral-nervöser Wirkung („central nervous system-acting drugs“, CNSADs) und mit einer hohen Nebenwirkungsrate („adverse drug reactions“, ADRs) wie Stürze, Frakturen und erhöhter Mortalität.

Fragestellung

Sind die Ergebnisse der kognitiven Tests mit dem Mini-Mental-State-Test (MMSE) von der CNSAD-Einnahme beeinflusst?

Setting

Die Untersuchung erfolgte in einer geriatrischen Klinik mit Akut-, Frührehabilitations- und weiterführenden Rehabilitationsbereich.

Methode

Mithilfe einer Sekundäranalyse wurden kombiniert Daten aus zwei prospektiven Kohortenstudien (PROPSYC, 2011 und AGE OUT, 2012) mit gleichem Design des kognitiven Assessments untersucht.

Ergebnisse

Die Analyse umfasste 395 Patienten, davon waren 144 Männer (M) und 251 Frauen (F). Das mittlere Alter betrug 80,0 ± 8,4 Jahre (M 76,7 ± 9,1, F 81,9 ± 7,3, p = 0,0000). Der mittlere MMSE lag bei 22,8 ± 4,8 Punkten (M 23,2 ± 4,6, F 22,6 ± 5,0, p = 0,211). Insgesamt 258 Patienten (65,3 %) erhielten CNSAD. Zentral wirksame Analgetika bekamen 117 Patienten (29,6 %). Niedrig-potente Analgetika wurden in 57 und hoch-potente in 60 Fällen gegeben. 60 Patienten erhielten Antidepressiva, 26 Sedativa und 11 Hypnotika. Andere CNSAD erhielten 38 Patienten. Signifikante Korrelationen mit den kognitiven Tests fanden wir nur für Sedativa (Diazepam und Oxazepam, Pearson r − 0,79, p = 0,05), aber nicht für Lorazepam.

Zusammenfassung

In unserer Analyse fanden wir nur für Sedativa (Diazepam und Oxazepam, aber nicht für Lorazepam) eine signifikante Korrelation mit dem Ergebnis der kognitiven Tests.

Schlüsselwörter

Kognition ZNS-aktive Medikamente MMSE Geriatrische Krankenhauspatientenen Neben- und Wechselwirkungen 
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Notes

Compliance with ethical guidelines

Conflict of interest. M. Gogol, H. Hartmann, S. Wustmann, and A. Simm state that there are no conflicts of interest. All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975 (in its most recently amended version). Informed consent was obtained from all patients included in the study.

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Copyright information

© Springer-Verlag 2014

Authors and Affiliations

  1. 1.Department of GeriatricsLindenbrunn HospitalCoppenbrüggeGermany
  2. 2.Interdisciplinary Centre for Ageing Halle (IZAH)Martin-Luther-Universität Halle-WittenbergHalleGermany

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