International Journal of Clinical Pharmacy

, Volume 40, Issue 5, pp 1292–1299 | Cite as

Psychotropic drug use and cognitive rehabilitation practice for elderly patients

  • Eiji KoseEmail author
  • Toshiyuki Hirai
  • Toshiichi Seki
Research Article


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 



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.


  1. 1.
    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
  2. 2.
    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
  3. 3.
    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
  4. 4.
    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
  5. 5.
    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
  6. 6.
    Kose E, Hirai T, Seki T, Hayashi H. The association of increased drugs use with activities of daily living and discharge outcome among elderly stroke patients. Int J Clin Pharm. 2018. Epub ahead of print.CrossRefPubMedGoogle Scholar
  7. 7.
    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. Epub ahead of print.CrossRefPubMedGoogle Scholar
  8. 8.
    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
  9. 9.
    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
  10. 10.
    Weintraub D, Tröster AI, Marras C, Stebbins G. Initial cognitive changes in Parkinson’s disease. Mov Disord. 2018. Scholar
  11. 11.
    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
  12. 12.
    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
  13. 13.
    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
  14. 14.
    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
  15. 15.
    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
  16. 16.
    Schliebs R, Arendt T. The cholinergic system in aging and neuronal degeneration. Behav Brain Res. 2011;221(2):555–63.CrossRefGoogle Scholar
  17. 17.
    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
  18. 18.
    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
  19. 19.
    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
  20. 20.
    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
  21. 21.
    Alic A, Pranjic N, Ramic E. Polypharmacy and decreased cognitive abilities in elderly patients. Med Arch. 2011;65(2):102–5.Google Scholar
  22. 22.
    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
  23. 23.
    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

Copyright information

© Springer Nature Switzerland AG 2018

Authors and Affiliations

  1. 1.Department of Pharmacotherapy, School of PharmacyNihon UniversityFunabashi-shiJapan
  2. 2.Department of PharmacyHitachinaka General HospitalHitachinaka-shiJapan

Personalised recommendations