Skip to main content
SpringerLink
Log in

Drug-Induced Cognitive Impairment in the Elderly

  • Disease Management
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Elderly people are more likely than younger patients to develop cognitive impairment as a result of taking medications. This reflects age- and disease-associated changes in brain neurochemistry and drug handling. Delirium (acute confusional state) is the cognitive disturbance most clearly associated with drug toxicity, but dementia has also been reported. The aetiology of cognitive impairment is commonly multifactorial, and it may be difficult to firmly establish a causal role for an individual medication.

In studies of elderly hospital patients, drugs have been reported as the cause of delirium in 11 to 30% of cases. Medication toxicity occurs in 2 to 12% of patients presenting with suspected dementia. In some cases CNS toxicity occurs in a dose-dependent manner, often as a result of interference with neurotransmitter function. Drug-induced delirium can also occur as an idiosyncratic complication. Finally, delirium may occur secondary to iatrogenic complications of drug use.

Almost any drug can cause delirium, especially in a vulnerable patient. Impaired cholinergic neurotransmission has been implicated in the pathogenesis of delirium and of Alzheimer’s disease. Anticholinergic medications are important causes of acute and chronic confusional states. Nevertheless, polypharmacy with anticholinergic compounds is common, especially in nursing home residents. Recent studies have suggested that the total burden of anticholinergic drugs may determine development of delirium rather than any single agent. Also, anticholinergic effects have been identified in many drugs other than those classically thought of as having major anticholinergic effects.

Psychoactive drugs are important causes of delirium. Narcotic agents are among the most important causes of delirium in postoperative patients. Long-acting benzodiazepines are the commonest drugs to cause or exacerbate dementia. Delirium was a major complication of treatment with tricyclic antidepressants but seems less common with newer agents. Anticonvulsants can cause delirium and dementia.

Drug-induced confusion with nonpsychoactive drugs is often idiosyncratic in nature, and the diagnosis is easily missed unless clinicians maintain a high index of suspicion. Histamine H2 receptor antagonists, cardiac medications such as digoxin and β-blockers, corticosteroids, non-steroidal anti-inflammatory agents and antibiotics can all cause acute, and, less commonly, chronic confusion.

Drug-induced confusion can be prevented by avoiding polypharmacy and adhering to the saying ‘start low and go slow’. Special care is needed when prescribing for people with cognitive impairment. Early diagnosis of drug-induced confusion, and withdrawal of the offending agent or agents is essential.

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. Williamson J, Chopin JM. Adverse reactions to prescribed drugs in the elderly: a multicentre study. Age Ageing 1980; 9: 73–80

    Article  CAS  PubMed  Google Scholar 

  2. Lipowski ZJ. Delirium: acute confusional state. Oxford: Oxford University Press, 1990

    Google Scholar 

  3. Rinn WE. Cognitive decline in normal aging. J Geriatr Psychiatry Neurol 1988; 1: 144–58

    Article  CAS  PubMed  Google Scholar 

  4. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edition. Washington, DC: American Psychiatric Association, 1994

    Google Scholar 

  5. O’Keeffe ST, Lavan JN. The clinical significance of delirium subtypes. Age Ageing 1999; 28: 115–9

    Article  PubMed  Google Scholar 

  6. Lindesay J, Macdonald A, Starke I. Delirium in the elderly. Oxford: Oxford University Press, 1990

    Google Scholar 

  7. Gibson GE, Blass JP, Huang H-M, et al. The cellular basis of delirium and its relevance to age-related disorder including Alzheimers disease. Int Psychogeriatr 1991; 3: 373–95

    Article  CAS  PubMed  Google Scholar 

  8. Ross CA. CNS arousal systems: possible role in delirium. Int Psychogeriatr 1991; 3: 353–71

    Article  CAS  PubMed  Google Scholar 

  9. O’Keeffe S, Lavan J. The prognostic significance of delirium in older hospital patients. J Am Geriatr Soc 1997; 45: 174–8

    PubMed  Google Scholar 

  10. Levkoff SE, Evans DA, Liptzin B, et al. Delirium: the occurrence and persistence of among hospitalized elderly patients. Arch Intern Med 1992; 152: 334–40

    Article  CAS  PubMed  Google Scholar 

  11. Francis J, Martin D, Kapoor WN. A prospective study of delirium in hospitalized elderly. JAMA 1990; 263: 1097–101

    Article  CAS  PubMed  Google Scholar 

  12. Inouye SK, Viscoli CM, Horwitz RI, et al. A predictive model for delirium in hospitalized elderly medical patients based on admission characteristics. Ann Intern Med 1993; 119: 474–81

    CAS  PubMed  Google Scholar 

  13. Francis J, Kapoor W. Prognosis after hospital discharge of older medical patients with delirium. J Am Geriatr Soc 1992; 40: 601–6

    CAS  PubMed  Google Scholar 

  14. Ritchie K, Kildea D. Is senile dementia ‘age-related’ or ‘ageing-related’ ? Evidence from meta-analysis of dementia prevalence in the oldest old. Lancet 1995; 346: 931–4

    Article  CAS  PubMed  Google Scholar 

  15. Bartus RT, Dean RL, Beer B, et al. The cholinergic hypothesis of geriatric memory dysfunction. Science 1982; 217: 408–17

    Article  CAS  PubMed  Google Scholar 

  16. Inouye SK, Charpentier PA. Precipitating factors for delirium in hospitalized elderly persons: predictive model and interrelationship with baseline vulnerability. JAMA 1996; 275: 852–7

    Article  CAS  PubMed  Google Scholar 

  17. George J, Bleasdale S, Singleton SJ. Causes and prognosis of delirium in elderly patients admitted to a district general hospital. Age Ageing 1997; 26: 423–7

    Article  CAS  PubMed  Google Scholar 

  18. Fishbain DA, Rotundo D. Frequency of hypoglycemic delirium in apsychiatric emergency service. Psychosomatics 1988; 29 (3): 346–8

    Article  CAS  PubMed  Google Scholar 

  19. Larson EB, Kukull WA, Buchner D, et al. Adverse drug reactions associated with global cognitive impairment in elderly persons. Ann Intern Med 1987; 107: 169–73

    CAS  PubMed  Google Scholar 

  20. Katz IR, Parmelee P, Brubaker K. Toxic and metabolic encephalopathies in long-term care patients. Int Psychogeriatr 1991; 3: 337–47

    Article  CAS  PubMed  Google Scholar 

  21. Starr JM, Whalley LJ. Drug induced dementia: incidence, management and prevention. Drug Saf 1994; 11: 310–17

    Article  CAS  PubMed  Google Scholar 

  22. Molchan SE, Martinez RA, Hill JL, et al. Increased cognitive sensitivity to scopolamine with age and a perspective on the scopolamine model. Brain Res 1992; 17: 215–26

    Article  CAS  Google Scholar 

  23. Tune LE, Bylsma FW. Benzodiazepine-induced and anticholinergic-induced delirium in the elderly. Int Psychogeriatr 1991; 3: 397–408

    Article  CAS  PubMed  Google Scholar 

  24. Blazer DG, Federspiel CF, Ray WA, et al. The risk of anticholinergic toxicity in the elderly: a study of prescribing practices in two populations. J Gerontol 1983; 38: 31–5

    Article  PubMed  Google Scholar 

  25. Itil T, Fink M. Anticholinergic drug induced delirium: experimental modification, quantitative EEG and behavioural correlations. J Nerv Ment Dis 1966; 143: 492–507

    Article  CAS  PubMed  Google Scholar 

  26. Nishiyama K, Momose T, Sugishita M, et al. Positron emission tomography of reversible intellectual impairment induced by long-term anticholinergic therapy. J Neurol Sci 1995; 132: 189–92

    Article  Google Scholar 

  27. Granacher RP, Baldeserini RJ. Physostigmine: its use in acute anticholinergic syndrome with antidepressant and antiparkinsonian drugs. Arch Gen Psychiatry 1975; 32: 375–80

    Article  CAS  PubMed  Google Scholar 

  28. O’Keeffe ST, Ni Chonchubhair A. Postoperative delirium in the elderly. Br J Anaesth 1994; 73: 673–87

    Article  PubMed  Google Scholar 

  29. Sheref SE. Pattern of CNS recovery following reversal of neuromuscular blockade: comparison of atropine and glycopyrollate. Br J Anaesth 1985; 57: 188–91

    Article  CAS  PubMed  Google Scholar 

  30. Summers WK, Reich TC. Delirium after cataract surgery: review and two cases. Am J Psychiatry 1979; 136: 386–91

    CAS  PubMed  Google Scholar 

  31. Feinberg M. The problems of anticholinergic adverse effects in older patients. Drugs Aging 1993; 3: 335–48

    Article  CAS  PubMed  Google Scholar 

  32. Cummings JL. Behavioural complications of drug treatment in Parkinson’s disease. J Am Geriatr Soc 1991; 39: 708–16

    CAS  PubMed  Google Scholar 

  33. De Smet Y, Ruberg M, Serdura M, et al. Confusion, dementia and anticholinergics in Parkinsons disease. J Neurol Neurosurg Psychiatry 1982; 45: 1161–4

    Article  PubMed  Google Scholar 

  34. Katz IR, Prouty Sands L, Bilker W, et al. Identification of medications that cause cognitive impairment in older people: the case of oxybutinin chloride. J Am Geriatr Soc 1998; 46: 8–13

    CAS  PubMed  Google Scholar 

  35. Donnellan CA, Fook L, McDonald P, et al. Oxybutinin and cognitive dysfunction. BMJ 1997; 315: 1363–4

    Article  CAS  PubMed  Google Scholar 

  36. Nebes RD, Pollock BG, Mulsant BH, et al. Low-level serum anticholinergicity as a source of baseline cognitive heterogeneity in geriatric depressed patients. Psychopharmacol Bull 1997; 33 (4): 715–20

    CAS  PubMed  Google Scholar 

  37. Tune LE, Holland A, Folstein M, et al. Association of postoperative delirium with raised serum levels of anti-cholinergic drugs. Lancet 1981; II: 651–2

    Article  Google Scholar 

  38. Tollefsen GD, Montague-Clouse J, Lancaster SP, et al. The relationship of serum anti-cholinergic activity to mental status performance in an elderly nursing home population. J Neuropsych Clin Neurosci 1991; 3: 314–19

    Google Scholar 

  39. Flacker JM, Cummings V, Mach Jr JR, et al. The association of serum anticholinergic activity with delirium in elderly medical patients. Am J Geriatr Psychiatry 1998; 6: 131–41

    Google Scholar 

  40. Tune LE, Carr S, Hoag E, et al. Anticholinergic effects of drugs commonly prescribed for the elderly: potential means for assessing risk of delirium. Am J Psychiatry 1992; 149: 1393–4

    CAS  PubMed  Google Scholar 

  41. Marcantonio ER, Juarez G, Goldman L, et al. The relationship of postoperative delirium with psychoactive medications. JAMA 1994; 272: 1518–22

    Article  CAS  PubMed  Google Scholar 

  42. Schor JD, Levkoff SE. Lipsitz LA, et al. Risk factors for delirium in hospitalized elderly. JAMA 1992; 267: 827–31

    Article  CAS  PubMed  Google Scholar 

  43. Foy A, O’Connell D, Henry DD, et al. Benzodiazepine use as a cause of cognitive impairment in elderly hospital patients. J Gerontol 1995; 50: M99–106

    CAS  Google Scholar 

  44. Egbert AM, Parks LH, Short LM, et al. Randomized trial of postoperative patient-controlled analgesia vs intramuscular narcotics in frail elderly men. Arch Intern Med 1990; 150: 1897–903

    Article  CAS  PubMed  Google Scholar 

  45. Miller RR, Jick H. Clinical effects of meperidine in hospitalized medical patients. J Clin Pharmacol 1978; 18: 180–9

    CAS  PubMed  Google Scholar 

  46. Eisendrath SJ, Goldman B, Douglas J, et al. Meperidine-induced delirium. Am J Psychiatry 1987 144: 1062–5

    CAS  PubMed  Google Scholar 

  47. Schmidt LG, Grohmann R, Strauss A, et al. Epidemiology of toxic delirium due to psychotropic drugs in hospital. Compr Psychiatry 1987; 28: 242–9

    Article  CAS  PubMed  Google Scholar 

  48. Snyder SH, Yamamura HI. Antidepressants and the muscarinic acetylcholine receptor. Arch Gen Psychiatry 1977; 34: 236–9

    Article  CAS  PubMed  Google Scholar 

  49. Ravena-Springer R, Dolberg OT, Hirshmann S, et al. Delirium in elderly patients treated with risperidone: a report of three cases. J Clin Psychopharmacol 1998; 18: 171–2

    Article  Google Scholar 

  50. Levenson JL. Neuroleptic malignant syndrome. N Engl J Med 1985; 313: 163–6

    Article  Google Scholar 

  51. Finucane P, Price C, Ghose K. Neuroleptic malignant syndrome in an elderly patient. BMJ 1988; 296: 14–18

    Article  Google Scholar 

  52. McShane RN, Keene J, Gedling K, et al. Do neuroleptics hasten cognitive decline in dementia? BMJ 1997; 314: 266–70

    Article  CAS  PubMed  Google Scholar 

  53. Bush DF, Liss CL, Morton A. An open multicentre long-term treatment evaluation of sinemet CR. Neurology 1989; 39 Suppl. 2: 101–4

    CAS  PubMed  Google Scholar 

  54. Lieberman AN, Goldstein M, Gopinathan G, et al. Further studies with pergolide in Parkinsons disease. Neurology 1982; 32: 1181–4

    Article  CAS  PubMed  Google Scholar 

  55. Kurlan R, Miller C, Levy R, et al. Long term experience with pergolide treatment of advanced parkinsonism. Neurology 1985; 35: 738–42

    Article  CAS  PubMed  Google Scholar 

  56. Lieberman AN, Goldstein M, Gopinathan G, et al. D-1 and D-2 agonists in Parkinsons disease. Can J Neurol Sci 1987; 14: 466–73

    CAS  PubMed  Google Scholar 

  57. Goetz CG, Tanner CM, Klawans HL. Pharmacology of hallucinations induced by long-term drug therapy. Am J Psychiatry 1982; 139: 494–7

    CAS  PubMed  Google Scholar 

  58. Burton K, Larsen A, Robinson RG, et al. Parkinsons disease: a comparison of mesulergine and bromocriptine. Neurology 1985; 35: 1205–8

    Article  CAS  PubMed  Google Scholar 

  59. Jankovic J, Orman J, Janssen B. Placebo-controlled study of mesulergine in Parkinsons disease. Neurology 1985; 35: 161–5

    Article  CAS  PubMed  Google Scholar 

  60. Knegtering H, Eijck M, Huijsman A. Effects of antidepressants on cognitive functioning of elderly patients: a review. Drugs Aging 1994; 5: 192–9

    Article  CAS  PubMed  Google Scholar 

  61. Grohmann R, Ströbel C, Rüther E, et al. Adverse psychic reactions to psychotropic drugs: a report from the AMUP study. Pharmacopsychiatry 1993; 3: 84–93

    Article  Google Scholar 

  62. Preskorn SH, Jerkovich GS. Central nervous system toxicity of tricyclic antidepressants: phenomenology, course, risk factors, and role of therapeutic drug monitoring. J Clin Psychopharmacol 1990; 2: 88–95

    Article  Google Scholar 

  63. Branconnier RJ, Cole JO. Effects of acute administration of trazadone and amitryptiline on cognition, cardiovascular function and salivation in the normal geriatric subject. J Clin Psychopharmacol 1986; 1 Suppl. 6: 825–8

    Google Scholar 

  64. Rudorfer MV, Manji HK, Potter WZ. Comparative tolerability profiles of the newer versus older antidepressants. Drug Saf 1994; 1: 18–46

    Article  Google Scholar 

  65. Sporer KA. The serotonin syndrome: implicated drugs, pathophysiology and management. Drug Saf 1995; 13: 94–104

    Article  CAS  PubMed  Google Scholar 

  66. Woo MH, Smythe MA. Association of SIADH with selective serotonin reuptake inhibitors. Ann Pharmacother 1997; 31: 108–10

    CAS  PubMed  Google Scholar 

  67. Smith SJ, Kocen RS. A Creutzfeldt-Jakob like syndrome due to lithium toxicity. J Neurol Neurosurg Psychiatry 1988; 51: 120–3

    Article  CAS  PubMed  Google Scholar 

  68. Foster JR, Gershell WJ, Goldfarb AI. Lithium treatment in the elderly: I. Clinical usage. J Gerontol 1977; 32: 299–302

    Article  CAS  PubMed  Google Scholar 

  69. Brown AS, Rosen J. Lithium-induced delirium with therapeutic serum lithium levels: a case report. J Geriatr Psychiatry Neurol 1992; 5: 53–5

    CAS  PubMed  Google Scholar 

  70. Trimble MR. Anticonvulsant drugs and cognitive function: a review of the literature. Epilepsia 1987; 28 Suppl. 3: S37–45

    Article  PubMed  Google Scholar 

  71. Aldenkamp AP, Vermeulen J. Phenytoin and carbamazepine: differential effects on cognitive function. Seizure 1995; 4: 95–104

    Article  CAS  PubMed  Google Scholar 

  72. Rosen JA. Dilantin dementia [letter]. Trans Am Neurol Assoc 1966; 93: 273

    Google Scholar 

  73. Brown CG, Kaminsky MJ, Feroli Jr ER, et al. Delirium with phenytoin and disulfiram administration. Ann Emerg Med 1983; 12: 310–13

    Article  CAS  PubMed  Google Scholar 

  74. Zaccara C, Campostrini R, Paganini M, et al. Long-term treatment with sodium valproate. Ther Drug Monit 1987; 9: 34–40

    Article  CAS  PubMed  Google Scholar 

  75. Cantó TG, Korek JS. Central nervous system reactions to histamine-2 receptor blockers. Ann Intern Med 1991; 114: 1027–34

    Google Scholar 

  76. Picotte-Prillmayer D, DiMaggio JR, Baile WE. H2 blocker delirium. Psychosomatics 1995; 36: 74–7

    Article  CAS  PubMed  Google Scholar 

  77. Fireman Z. Central nervous system side effects after proton pump inhibitor treatment. J Clin Gastroenterol 1997; 4: 718–22

    Article  Google Scholar 

  78. Das AF, Freston JW, Jacobs J, et al. An evaluation of safety in 37,252 patients treated with cimetidine or ranitidine. Intern Med 1990; 11: 3–14

    Google Scholar 

  79. Porter JB, Beard K, Walker AM, et al. Intensive hospital monitoring study of intravenous cimetidine. Arch Intern Med 1986; 146: 2237–9

    Article  CAS  PubMed  Google Scholar 

  80. Kowalsky SF, Andritz MB, Calvert JF, et al. Aprospective evaluation of cimetidine drug use. Hosp Pharm 1989; 24: 105–8

    CAS  PubMed  Google Scholar 

  81. Schentag JJ, Cerra FB, Calleri G, et al. Pharmacokinetic and clinical studies in patients with cimetidine-induced mental confusion. Lancet 1979; I: 117–81

    Google Scholar 

  82. Cerra FB, Schentag JJ, McMillen M, et al. Mental status, the intensive care unit and cimetidine. Ann Surg 1982; 196: 565–70

    Article  CAS  PubMed  Google Scholar 

  83. Slugg PH, Haug MT, Pippenger CE. Ranitidine pharmacokinetics and adverse central nervous system reactions. Arch Intern Med 1992; 152: 2325–9

    Article  CAS  PubMed  Google Scholar 

  84. Kimelblatt BJ, Cerra FB, Calleri G, et al. Dose and serum concentration relationships in cimetidine-associated mental confusion. Gastroenterology 1980; 78: 791–5

    CAS  PubMed  Google Scholar 

  85. Jenike MA, Levy JC. Physostigmine reversal of cimetidine-induced delirium and agitation. J Clin Psychopharmacol 1983; 3: 43–4

    Article  CAS  PubMed  Google Scholar 

  86. Mogelnicki SR, Waller JL, Finlayson DC. Physostigmine reversal of cimetidine-induced mental confusion. JAMA 1979; 241: 826–7

    Article  CAS  PubMed  Google Scholar 

  87. McDonnell Cooke D. The use of central nervous system manifestations in the early detection of digitalis toxicity. Heart Lung 1993; 22: 477–81

    Google Scholar 

  88. Lely AH, Van Enter JC. Non-cardiac symptoms of digitalis intoxication. Am Heart J 1972; 83: 149–52

    Article  CAS  PubMed  Google Scholar 

  89. Eisendrath SJ, Sweeney MA. Toxic neuropsychiatric effects of digoxin at therapeutic serum concentrations. Am J Psychiatry 1987; 144: 506–7

    CAS  PubMed  Google Scholar 

  90. Deleu D, Schmedding E. Acute psychosis as idiosyncratic reaction to quinidine: report of two cases. BMJ 1987; 294: 1001–2

    Article  CAS  PubMed  Google Scholar 

  91. Jacobson FM, Sack DA, James SP. Delirium induced by verapamil [letter]. Am J Psychiatry 1990; 144: 248

    Google Scholar 

  92. Gillman MNA, Sandyk R. Reversal of captopril-induced psychosis with naloxone [letter]. Am J Psychiatry 1988; 142: 270

    Google Scholar 

  93. Trohman RG, Castellanos D, Castellanos A, et al. Amiodarone-induced delirium. Ann Intern Med 1988; 108: 68–9

    CAS  PubMed  Google Scholar 

  94. Pfeifer HJ, Greenblatt DJ, Koch-Weiser J. Clinical use and toxicity of intravenous lidocaine (a report from the Boston Collaborative Drug Surveillance Program). Am Heart J 1978; 92: 168–73

    Article  Google Scholar 

  95. Saravay SM, Marke J, Steinburg MD, et al. ‘Doom anxiety’ and delirium in lidocaine toxicity. Am J Psychiatry 1987; 144: 159–63

    CAS  PubMed  Google Scholar 

  96. Dimsdale JE, Newton RP, Joist T. Neuropsychological side effects of beta-blockers. Arch Intern Med 1989; 149: 514–25

    Article  CAS  PubMed  Google Scholar 

  97. Rogers TK, Bowman CE. Cognitive impairment associated with beta-blockade in the elderly. Postgrad Med J 1990; 66: 1050–2

    Article  CAS  PubMed  Google Scholar 

  98. Fisher CM. Amnestic syndrome associated with propranolol toxicity: a case report. Clin Neuropharmacol 1992; 15: 397–403

    Article  CAS  PubMed  Google Scholar 

  99. Nygaard HA, Hovding G. Adverse effects of local use of beta blockers in glaucoma. Tidsskr Nor Laegeforen 1997; 117: 2019–21

    CAS  PubMed  Google Scholar 

  100. Paykel ES, Fleminger R, Watson JP. Psychiatric side effects of antihypertensive drugs other than reserpine. J Clin Psychopharmacol 1982; 2: 14–39

    Article  CAS  PubMed  Google Scholar 

  101. Patten SB, Love EJ. Neuropsychiatric adverse drug reactions: passive reports to health and welfare Canada’s adverse drug reaction database (1965-present). Int J Psychiatry Med 1994; 24: 145–62

    Article  Google Scholar 

  102. Boston Collaborative Drug Surveillance Program. Acute adverse reactions to prednisone in relation to dose. Clin Pharmacol Ther 1972; 13: 694–8

    Google Scholar 

  103. Varney NR, Alexander B, Maclndoe JH. Reversible steroid dementia in patient without steroid psychosis. J Nerv Ment Dis 1980; 168: 753–7

    Article  Google Scholar 

  104. O’Keeffe S, Devlin JG. Delirium and the dexamethasone suppression test in the elderly. Neuropsychobiology 1994; 30: 153–6

    Article  PubMed  Google Scholar 

  105. Lupien S, Lecours AR, Lussier I, et al. Basal Cortisol levels and cognitive decline in human aging. J Neurosci 1994; 14: 2893–903

    CAS  PubMed  Google Scholar 

  106. Sapolsky R. Glucocorticoids, stress and exacerbation of excitotoxic neuron death. Semin Neurosci 1994; 6: 323–31

    Article  CAS  Google Scholar 

  107. Grigor RR, Spitz PW, Furst DE, et al. Salicylate toxicity in elderly patients with rheumatoid arthritis. J Rheumatol 1987; 14: 60–6

    CAS  PubMed  Google Scholar 

  108. Steele TE, Morton WA. Salicylate induced delirium. Psychosomatics 1986; 27: 455–6

    Article  CAS  PubMed  Google Scholar 

  109. Carney MPW. Paranoid psychosis with indomethacin. BMJ 1977; 2: 994–5

    Article  CAS  PubMed  Google Scholar 

  110. Schwartz JI, Moura RJ. Severe depersonalization and anxiety associated with indomethacin. South Med J 1983; 76: 679–80

    Article  CAS  PubMed  Google Scholar 

  111. Thornton T. Delirium associated with sulindac. JAMA 1980; 243: 1630–1

    Article  CAS  PubMed  Google Scholar 

  112. Kruis R, Barger R. Paranoid psychosis with sulindac [letter]. JAMA 1980; 243: 1420

    Article  CAS  PubMed  Google Scholar 

  113. Goodwin JS, Regan M. Cognitive dysfunction associated with naproxen and ibuprofen in the elderly. Arthritis Rheum 1982; 25: 1013–15

    Article  CAS  PubMed  Google Scholar 

  114. Snavely SR, Hodges GR. The neurotoxicity of antibacterial agents. Ann Intern Med 1984; 101: 92–104

    CAS  PubMed  Google Scholar 

  115. Schliamser SE, Cars O, Norrby SR. Neurotoxicity of betalactam antibiotics: predisposing factors and pathogenesis. J Antimicrob Chemother 1991; 27: 405–25

    Article  CAS  PubMed  Google Scholar 

  116. Nicholls PJN. Neurotoxicity of penicillin. J Antimicrob Chemother 1980; 6: 161–5

    Article  CAS  PubMed  Google Scholar 

  117. Downham TF, Cawley RA, Salley SO, et al. Systemic toxic reactions to procaine penicillin G. Sex Transm Dis 1978; 5: 4–9

    Article  PubMed  Google Scholar 

  118. Slaker RA, Danielson B. Neurotoxicity associated with ceftazidime therapy in geriatric patients with renal dysfunction. Pharmacotherapy 1991; 4: 351–2

    Google Scholar 

  119. Thomas RJ, Reagan DR. Association of a Tourette-like syndrome with ofloxacin. Ann Pharmacother 1996; 30: 138–41

    CAS  PubMed  Google Scholar 

  120. Andrejak M, Schmit JL, Tondriaux A, et al. Neurologic side effects of fluoroquinolones. Therapie 1992; 47: 415–18

    CAS  PubMed  Google Scholar 

  121. Keller H. Comparison of the adverse effect profile of different substances such as penicillins, tetracyclines, sulfonamides and quinolones. Infection 1991; 19 Suppl. 1: S19–24

    PubMed  Google Scholar 

  122. Antoniadis A, Múller WE, Wollert U. Benzodiazepine receptor interactions may be involved in the neurotoxicity of various penicillin derivatives. Ann Neurol 1980; 8: 71–3

    Article  CAS  PubMed  Google Scholar 

  123. Tombaugh TN, Mclntyre NJ. The Mini-Mental State Examination: a comprehensive review. J Am Geriatr Soc 1992; 40: 922–35

    CAS  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Geriatric Medicine, St Vincent’s Hospital, Dublin, Ireland

    Alan R. Moore &  Shaun T. O’Keeffe

Authors
  1. Alan R. Moore
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Shaun T. O’Keeffe
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Shaun T. O’Keeffe.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Moore, A.R., O’Keeffe, S.T. Drug-Induced Cognitive Impairment in the Elderly. Drugs & Aging 15, 15–28 (1999). https://doi.org/10.2165/00002512-199915010-00002

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.2165/00002512-199915010-00002

Keywords

Search

Navigation