Association between prescribed central nervous system depressant drugs, comorbidity and cognition among hospitalised older patients: a cross-sectional study

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Abstract

Objectives

Central nervous system depressants (CNSDs) such as opioids, benzodiazepine and Z-hypnotics are commonly used. However, CNSDs may influence cognitive function, especially in older hospitalised patients with comorbidities. The aim was to examine the association between CNSD use and cognitive function in older patients. We assessed global and domain specific cognitive function, among hospitalised older patients, including covariates for comorbidity, anxiety and depression.

Design

Cross-sectional hospital-based study.

Settings

Data was collected consecutively from inpatients at somatic wards of a general university hospital.

Participants

Older patients between 65 and 90 years with/without CNSD use for ≥4 weeks.

Outcome measures

The main outcome was cognitive function assessed by Cognistat. Secondary outcomes were routine clinical tests in the wards (mini-mental state examination (MMSE), trail making test (TMT) A and B, and clock drawing tests). Analyses were bivariate and multiple linear regression, adjusted for age, gender, and education. Covariates were comorbidity, depression and anxiety scores.

Results

The main result indicated that CNSD users (n=100) had (β=–3.4, 95% CI 6.27 to –0.58, p=0.017) lower Cognistat score than non-users (n=146), adjusted for age, gender, education, anxiety and depression, but not significant when including covariate for comorbidity (β= –2.50 - 5.45; –0.46, p=0.097). Comorbidity was associated with cognitive function (β=−0.77, 95% CI −1.22 to −0.14, p=0.014). Cognistat subdimensions associated with CNSD use were language (p=0.017) and calculation (p=0.003). In clock drawing test, users had lower scores than non-users (β=−0.80, 95% CI 1.24 to −0.36, p=0.004), but no significant difference was found with MMSE and TMT A or B. Z-hypnotics were associated with reduced cognitive function.

Conclusion

Among older hospitalised patients, global cognition and specific cognitive functions were associated with long-term use of CNSD medication as well as with somatic comorbidity.

Trial registration number

NCT03162081, 22 May 2017.

Related collections

Most cited references 40

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Polypharmacy in elderly patients.

Emily Hajjar, Angela Cafiero, Joseph Hanlon (2007)

Polypharmacy (ie, the use of multiple medications and/or the administration of more medications than are clinically indicated, representing unnecessary drug use) is common among the elderly. The goal of this research was to provide a description of observational studies examining the epidemiology of polypharmacy and to review randomized controlled studies that have been published in the past 2 decades designed to reduce polypharmacy in older adults. Materials for this review were gathered from a search of the MEDLINE database (1986-June 2007) and International Pharmaceutical Abstracts (1986-June 2007) to identify articles in people aged >65 years. We used a combination of the following search terms: polypharmacy, multiple medications, polymedicine, elderly, geriatric, and aged. A manual search of the reference lists from identified articles and the authors' article files, book chapters, and recent reviews was conducted to identify additional articles. From these, the authors identified those studies that measured polypharmacy. The literature review found that polypharmacy continues to increase and is a known risk factor for important morbidity and mortality. There are few rigorously designed intervention studies that have been shown to reduce unnecessary polypharmacy in older adults. The literature review identified 5 articles, which are included here. All studies showed an improvement in polypharmacy. Many studies have found that various numbers of medications are associated with negative health outcomes, but more research is needed to further delineate the consequences associated with unnecessary drug use in elderly patients. Health care professionals should be aware of the risks and fully evaluate all medications at each patient visit to prevent polypharmacy from occurring.

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Epidemiology of insomnia: a longitudinal study in a UK population.

Hannah Morphy, Martyn Lewis, Quentin P. Croft … (2007)

To investigate the incidence, persistence, and consequences of insomnia and their associations with psychological health and pain. A population based, longitudinal, cohort study using postal questionnaires at baseline and 12-month follow-up. Sleep problems in the past month were assessed using 4 questions: insomnia was defined as having at least 1 of the sleep problems "on most nights." Questions about psychological health, presence of pain at different sites, and demographic details were included in the questionnaire. Five general practices in Staffordshire, UK. The questionnaire was mailed to a random sample of 4885 adults aged 18 years and over registered with these practices. There were 2662 questionnaires returned. Of the responders, 2363 completed all 4 sleep questions at baseline: 870 (37%) had insomnia and 1493 (63%) did not have insomnia. Of those without insomnia at baseline, the incidence of insomnia at 12 months was 15%, and this was significantly associated with baseline anxiety, depression, and pain. Of those who did have insomnia at baseline, 69% had insomnia at 12-month follow-up; persistence of insomnia was significantly associated with older age. Insomnia at baseline was significantly associated with incidence of anxiety, depression, and widespread pain at 12-month follow-up. Insomnia is common and often persistent. Older people appear more vulnerable to persistent symptoms. Our results provide evidence that the common problems of insomnia, pain, and psychological distress are intertwined and suggest that combined approaches to treatment may be needed to reduce the onset and persistence of these problems in the community.

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Is Open Access

Alcohol Use Disorders Identification Test (AUDIT): an updated systematic review of psychometric properties

Izilda Meneses-Gaya, Antonio Zuardi, Sonia Regina Loureiro … (2009)

The Alcohol Use Disorders Identification Test (AUDIT) is an instrument used to screen for alcohol-related problems. It has been increasingly used in many different countries in both the original English-language version and its many translated versions. Because of the need for screening instruments of faster administration, shortened versions of the AUDIT have also been developed. This study was aimed at expanding the work by Berner and colleagues (2007) in an attempt to answer some remaining questions as well as to identify and evaluate studies on the validation of modified versions of the AUDIT, which have not been previously analyzed. In order to do so, we identified indexed articles published between 2002 and 2009 related to the psychometric qualities of the AUDIT by matching the keywords: alcohol, Alcohol Use Disorders Identification Test, and AUDIT. We found 47 articles that evaluated the AUDIT in different countries and in diverse health and community contexts, involving adolescent, adult, and elderly samples. The studies confirmed the validity and efficiency of the AUDIT in the identification of harmful use, abuse, and dependence of alcohol, both in the original version and in modified ones. The possibility of using brief and efficient versions is of great value, since certain health contexts demand faster assessment. The results also showed that the reduced versions have satisfactory psychometric qualities, sometimes with sensitivity values higher than those of the AUDIT itself. The studies analyzed confirm the efficiency of the AUDIT both in its original, reduced, and language-adapted versions in different contexts and cultures.

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Author and article information

Journal

Journal ID (nlm-ta): BMJ Open

Journal ID (iso-abbrev): BMJ Open

Journal ID (hwp): bmjopen

Journal ID (publisher-id): bmjopen

Title: BMJ Open

Publisher: BMJ Publishing Group (BMA House, Tavistock Square, London, WC1H 9JR )

ISSN (Electronic): 2044-6055

Publication date Collection: 2020

Publication date (Electronic): 27 July 2020

Volume: 10

Issue: 7

Electronic Location Identifier: e038432

Affiliations

[1 ]departmentHealth Services Research Unit (HØKH) , Akershus University Hospital , Lorenskog, Norway

[2 ]departmentInstitute of Clinical Medicine, Faculty of Medicine , University of Oslo , Oslo, Norway

[3 ]departmentCentre for Addiction Research , King's College London , London, UK

[4 ]departmentDepartment of General Practice, Institute of Health and Society , University of Oslo , Oslo, Norway

[5 ]departmentDepartment of Psychology , Norwegian University of Science and Technology , Trondheim, Norway

[6 ]departmentDepartment of Neurology , Akershus University Hospital , Lorenskog, Norway

Author notes

[Correspondence to ] Tahreem Ghazal Siddiqui; tahs@ 123456ahus.no

Author information

Tahreem Ghazal Siddiqui http://orcid.org/0000-0002-8404-0610

Socheat Cheng http://orcid.org/0000-0003-2277-7585

Espen Saxhaug Kristoffersen http://orcid.org/0000-0002-8999-5424

Christofer Lundqvist http://orcid.org/0000-0002-2596-9876

Article

Publisher ID: bmjopen-2020-038432

DOI: 10.1136/bmjopen-2020-038432

PMC ID: 7389767

PubMed ID: 32718926

SO-VID: b158423c-2ec0-459b-ad8b-811202c81c9b

License:

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

History

Date received : 10 March 2020

Date revision received : 05 June 2020

Date accepted : 19 June 2020

Funding

Funded by: Health Services Research Unit of the Akershus University Hospital;

Award ID: N/A

Funded by: FundRef http://dx.doi.org/10.13039/501100005416, Norges Forskningsråd;

Award ID: 256431

Funded by: South Eastern Norway Regional health authority;

Award ID: N/A

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special-feature unlocked

ScienceOpen disciplines: Medicine

Keywords: geriatric medicine,old age psychiatry,clinical pharmacology,substance misuse

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ScienceOpen disciplines: Medicine

Keywords: geriatric medicine, old age psychiatry, clinical pharmacology, substance misuse

Association between prescribed central nervous system depressant drugs, comorbidity and cognition among hospitalised older patients: a cross-sectional study

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Abstract

Objectives

Design

Settings

Participants

Outcome measures

Results

Conclusion

Trial registration number

Related collections

Neuropharmacology and Therapy

Most cited references 40

Polypharmacy in elderly patients.

Epidemiology of insomnia: a longitudinal study in a UK population.

Alcohol Use Disorders Identification Test (AUDIT): an updated systematic review of psychometric properties

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Author notes

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