Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility.

Gilles Loggia,Elpidio Attoh-Mensah,Chantal Chavoix,Pascale Lescure,Rémy Morello,Christian Marcelli,Kristell Pothier,Marie-Laure Bocca

doi:10.3389/fphar.2019.01659

Abstract

ObjectivesWith their broad spectrum of action, psychotropic drugs are among the most common medications prescribed to the elderly. Consequently, the number of older adults taking multiple psychotropic drugs has more than doubled over the last decade. To improve knowledge about the deleterious effects of psychotropic polypharmacy, we investigated whether there is a threshold number of psychotropic molecules that could lead to impairment of global cognition, executive function, or mobility. Furthermore, relationships between the number of psychotropic molecules and cognitive and mobility impairment were examined.DesignCross-sectional studySettingUniversity Hospital of Caen (France) and advertisements in medical officesParticipantsCommunity-dwelling older adults 55 years and older (n = 177; 69.8 ± 9.3 years; 81% women)MeasurementsNumber of psychotropic molecules taken daily, global cognition assessed with the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), processing speed with the Trail Making Test (TMT) A, executive function with the TMT B and TMT B-A, and mobility with the Time Up and Go (TUG). The threshold numbers of psychotropic molecules were determined by ROC curves analysis. Based on these threshold values, multinomial logistic regression adjusting for covariates was then performed.ResultsLogistic regressions showed that the threshold of two daily psychotropic molecules, identified by the ROC curves analysis, increases the risk of impaired executive function (p = .05 and.005 for the TMT B and TMT B-A, respectively), global cognition (p = .006 and.001 for the MMSE and MoCA, respectively), and mobility (p = .005 for the TUG), independent of confounding factors, including comorbidities. Furthermore, psychotropic polypharmacy would affect mobility through executive functions.ConclusionImpairment of global cognition, executive function, and mobility when as few as two psychotropic molecules are consumed in relatively healthy young older adults should alert physicians when prescribing combinations of psychotropic medications.

Highlights

Polypharmacy, usually defined as the concomitant daily use of five or more medications (Gnjidic et al, 2012), is increasingly common
It should be pointed out that impaired performance in participants was found in 31% for the Time Up and Go (TUG), 29% for the Montreal Cognitive Assessment (MoCA), 15% for the Trail Making Test (TMT) A, 15% for the TMT, 11% for the TMT B-A, and 8% for the Mini Mental State Examination (MMSE) (Table 1)
The analyzes showed that participants taking two or more psychotropic molecules had a significant increased risk for impaired MMSE (Model 3.1), MoCA (Model 3.2), TMT B (Model 3.4), TMT B-A (Model 3.5), and impaired TUG (Model 3.6), independent of confounding factors

Summary

Introduction

Polypharmacy, usually defined as the concomitant daily use of five or more medications (Gnjidic et al, 2012), is increasingly common. It is, associated with serious adverse events such as falls, frailty, disability, and mortality in older adults (Lai and Liao, 2013; Maher et al, 2014; Moulis et al, 2015). We previously showed that community-dwelling older adults 55 years and over who took five or more medicinal molecules per day were at high risk for both impaired global cognition and mobility (Langeard et al, 2016); executive function and specific involvement of the different pharmacological classes were not investigated

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