Background Psychotropic drugs were associated with greater risks of adverse drug reactions, including lower the level of consciousness, cause cognitive dysfunction, relax muscles, cause hypotension and others. However, the effect of psychotropic drug use on rehabilitation outcomes is poorly documented in Japan. Objective To assess the association of increased psychotropic drugs during hospitalization with activities of daily living among elderly patients. Setting This study was conducted at the convalescent rehabilitation ward in the Hitachinaka General Hospital in Japan. Method This retrospective longitudinal cohort study included consecutive patients aged ≥ 65 years between 2010 and 2016. Participants were divided based on presence or absence of increased psychotropic drugs including benzodiazepines, antidepressants, antipsychotics, and antiepileptic drugs during hospitalization. Functional recovery was assessed by the Functional Independence Measure (FIM). Multivariate analyses were performed, adjusting for confounding factors. Main outcome measures Cognitive gain in the Functional Independence Measure. Results We included 631 participants (227 males, 404 females) with a median age of 78 years (interquartile range 73–84 years). Multiple regression analysis revealed that change in psychotropic drug use, cognitive FIM at admission, and age were independently and negatively correlated with cognitive FIM gain. Multiple logistic regression analysis indicated that the “Comprehension” and “Memory” items of the cognitive FIM gain were independently and negatively associated with increased psychotropic drug use. Conclusion Increased psychotropic drug use during hospitalization may predict limited the improvement of cognitive activities of daily living in geriatric patients.
Activities of daily living Cognitive function Functional independence measure Japan Psychotropic drug
This is a preview of subscription content, log in to check access.
The authors thank the manager of Hitachinaka General Hospital who agreed for this study to take place.
Conflicts of interest
The authors declare no conflict of interest.
Eitan N, Levin Y, Ben-Artzi E, Levy A, Neumann M. Effects of antipsychotic drugs on memory functions of schizophrenic patients. Acta Psychiatr Scand. 1992;85(1):74–6.CrossRefGoogle Scholar
Glass J, Lanctôt KL, Herrmann N, Sproule BA, Busto UE. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ. 2005;331(7526):1169–73.CrossRefGoogle Scholar
Kose E, Hirai T, Seki T, Hayashi H. Role of potentially inappropriate medication use in rehabilitation outcomes for geriatric patients after strokes. Geriatr Gerontol Int. 2018;18(2):321–8.CrossRefGoogle Scholar
Kose E, Maruyama R, Okazoe S, Hayashi H. Impact of polypharmacy on the rehabilitation outcome of japanese stroke patients in the convalescent rehabilitation ward. J Aging Res. 2016;2016:7957825.CrossRefGoogle Scholar
Kose E, Toyoshima M, Okazoe S, Oka R, Shiratsuchi Y, Hayashi H. The relationship between polypharmacy and recovery of activities of daily living among convalescent stroke patients: a propensity score-matched analysis. Eur Geriatr Med. 2017;8(3):250–5.CrossRefGoogle Scholar
Kose E, Hirai T, Seki T, Hidaka S, Hamamoto T. Anticholinergic load negatively correlates with recovery of cognitive activities of daily living for geriatric patients after stroke in the convalescent stage. J Clin Pharm Ther. 2018. https://doi.org/10.1111/jcpt.12706Epub ahead of print.CrossRefPubMedGoogle Scholar
Kose E, Hirai T, Seki T. Clinical factors affecting potentially inappropriate medications at discharge in older stroke patients. Eur Geriatr Med. 2018;9(2):161–8.CrossRefGoogle Scholar
Dutzi I, Schwenk M, Kirchner M, Bauer JM, Hauer K. Cognitive change in rehabilitation patients with dementia: prevalence and association with rehabilitation success. J Alzheimers Dis. 2017;60(3):1171–82.CrossRefGoogle Scholar
Niikawa H, Okamura T, Ito K, Ura C, Miyamae F, Sakuma N, et al. Association between polypharmacy and cognitive impairment in an elderly Japanese population residing in an urban community. Geriatr Gerontol Int. 2017;17(9):1286–93.CrossRefGoogle Scholar
Ottenbacher KJ, Hsu Y, Granger CV, Fiedler RC. The reliability of the functional independence measure:a quantitative review. Arch Phys Med Rehabil. 1996;77(12):1226–32.CrossRefGoogle Scholar
Gray SL, Dublin S, Yu O, Walker R, Anderson M, Hubbard RA, et al. Benzodiazepine use and risk of incident dementia or cognitive decline: prospective population based study. BMJ. 2016;352:i90.CrossRefGoogle Scholar
Barker MJ, Greenwood KM, Jackson M, Crowe SF. Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs. 2004;18(1):37–48.CrossRefGoogle Scholar
Blazer DG 2nd, Federspiel CF, Ray WA, Schaffner W. The risk of anticholinergic toxicity in the elderly: a study of prescribing practices in two populations. J Gerontol. 1983;38(1):31–5.CrossRefGoogle Scholar
Schliebs R, Arendt T. The cholinergic system in aging and neuronal degeneration. Behav Brain Res. 2011;221(2):555–63.CrossRefGoogle Scholar
Gray SL, Anderson ML, Dublin S, Hanlon JT, Hubbard R, Walker R, et al. Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Intern Med. 2015;175(3):401–7.CrossRefGoogle Scholar
Pan YJ, Wu CS, Gau SS, Chan HY, Banerjee S. Antipsychotic discontinuation in patients with dementia: a systematic review and meta-analysis of published randomized controlled studies. Dement Geriatr Cogn Disord. 2014;37(3–4):125–40.CrossRefGoogle Scholar
Nishioka S, Wakabayashi H, Yoshida T, Mori N, Watanabe R, Nishioka E. Obese Japanese patients with stroke have higher functional recovery in convalescent rehabilitation wards: a retrospective cohort study. J Stroke Cerebrovasc Dis. 2016;25(1):26–33.CrossRefGoogle Scholar
Lagnaoui R, Bégaud B, Moore N, Chaslerie A, Fourrier A, Letenneur L, et al. Benzodiazepine use and risk of dementia: a nested case–control study. J Clin Epidemiol. 2002;55(3):314–8.CrossRefGoogle Scholar
Alic A, Pranjic N, Ramic E. Polypharmacy and decreased cognitive abilities in elderly patients. Med Arch. 2011;65(2):102–5.Google Scholar
Lai SW, Lin CH, Liao KF, Su LT, Sung FC, Lin CC. Association between polypharmacy and dementia in older people: a population-based case-control study in Taiwan. Geriatr Gerontol Int. 2012;12(3):491–8.CrossRefGoogle Scholar
Jyrkkä J, Enlund H, Lavikainen P, Sulkava R, Hartikainen S. 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(5):514–22.CrossRefGoogle Scholar