Clinical Pharmacology Mannheim, Faculty of Medicine Mannheim, Ruprecht-Karls-University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167, Mannheim, Germany.
Section of Geriatrics, Department of Internal Medicine and Paediatrics, Ghent University, Ghent, Belgium.
Drugs Aging. 2022 Nov;39(11):863-874. doi: 10.1007/s40266-022-00980-9. Epub 2022 Oct 26.
Cognitive decline is common in older people. Numerous studies point to the detrimental impact of polypharmacy and inappropriate medication on older people's cognitive function. Here we aim to systematically review evidence on the impact of medication optimisation and drug interventions on cognitive function in older adults.
A systematic review was performed using MEDLINE and Web of Science on May 2021. Only randomised controlled trials (RCTs) addressing the impact of medication optimisation or pharmacological interventions on quantitative measures of cognitive function in older adults (aged > 65 years) were included. Single-drug interventions (e.g., on drugs for dementia) were excluded. The quality of the studies was assessed by using the Jadad score.
Thirteen studies met the inclusion criteria. In five studies a positive impact of the intervention on metric measures of cognitive function was observed. Only one study showed a significant improvement of cognitive function by medication optimisation. The remaining four positive studies tested methylphenidate, selective oestrogen receptor modulators, folic acid and antipsychotics. The mean Jadad score was low (2.7).
This systematic review identified a small number of heterogenous RCTs investigating the impact of medication optimisation or pharmacological interventions on cognitive function. Five trials showed a positive impact on at least one aspect of cognitive function, with comprehensive medication optimisation not being more successful than focused drug interventions. More prospective trials are needed to specifically assess ways of limiting the negative impact of certain medication in particular and polypharmacy in general on cognitive function in older patients.
认知能力下降在老年人中很常见。许多研究指出，多种药物治疗和不当用药会对老年人的认知功能产生不利影响。在这里，我们旨在系统地回顾关于药物优化和药物干预对老年人认知功能影响的证据。
我们于 2021 年 5 月在 MEDLINE 和 Web of Science 上进行了系统评价。仅纳入了评估药物优化或药物干预对 65 岁以上老年人认知功能的定量指标影响的随机对照试验（RCT）。排除了单药干预（例如，针对痴呆症的药物）。使用 Jadad 评分评估研究质量。
符合纳入标准的研究有 13 项。其中 5 项研究观察到干预对认知功能的度量指标有积极影响。只有一项研究显示药物优化可显著改善认知功能。其余四项阳性研究测试了哌醋甲酯、选择性雌激素受体调节剂、叶酸和抗精神病药。平均 Jadad 评分较低（2.7）。
本系统评价确定了少数异质性 RCT，这些 RCT 调查了药物优化或药物干预对认知功能的影响。五项试验显示至少在认知功能的一个方面有积极影响，全面的药物优化并不比有针对性的药物干预更成功。需要更多的前瞻性试验来专门评估限制某些药物在特定患者和一般老年人中药物滥用对认知功能的负面影响的方法。
