Cargando…

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

OBJECTIVES: With 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 effe...

Descripción completa

Detalles Bibliográficos
Autores principales: Loggia, Gilles, Attoh-Mensah, Elpidio, Pothier, Kristell, Morello, Rémy, Lescure, Pascale, Bocca, Marie-Laure, Marcelli, Christian, Chavoix, Chantal
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002919/
https://www.ncbi.nlm.nih.gov/pubmed/32082159
http://dx.doi.org/10.3389/fphar.2019.01659
_version_ 1783494445793017856
author Loggia, Gilles
Attoh-Mensah, Elpidio
Pothier, Kristell
Morello, Rémy
Lescure, Pascale
Bocca, Marie-Laure
Marcelli, Christian
Chavoix, Chantal
author_facet Loggia, Gilles
Attoh-Mensah, Elpidio
Pothier, Kristell
Morello, Rémy
Lescure, Pascale
Bocca, Marie-Laure
Marcelli, Christian
Chavoix, Chantal
author_sort Loggia, Gilles
collection PubMed
description OBJECTIVES: With 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. DESIGN: Cross-sectional study SETTING: University Hospital of Caen (France) and advertisements in medical offices PARTICIPANTS: Community-dwelling older adults 55 years and older (n = 177; 69.8 ± 9.3 years; 81% women) MEASUREMENTS: Number 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. RESULTS: Logistic 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. CONCLUSION: Impairment 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.
format Online
Article
Text
id pubmed-7002919
institution National Center for Biotechnology Information
language English
publishDate 2020
publisher Frontiers Media S.A.
record_format MEDLINE/PubMed
spelling pubmed-70029192020-02-20 Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility Loggia, Gilles Attoh-Mensah, Elpidio Pothier, Kristell Morello, Rémy Lescure, Pascale Bocca, Marie-Laure Marcelli, Christian Chavoix, Chantal Front Pharmacol Pharmacology OBJECTIVES: With 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. DESIGN: Cross-sectional study SETTING: University Hospital of Caen (France) and advertisements in medical offices PARTICIPANTS: Community-dwelling older adults 55 years and older (n = 177; 69.8 ± 9.3 years; 81% women) MEASUREMENTS: Number 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. RESULTS: Logistic 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. CONCLUSION: Impairment 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. Frontiers Media S.A. 2020-01-30 /pmc/articles/PMC7002919/ /pubmed/32082159 http://dx.doi.org/10.3389/fphar.2019.01659 Text en Copyright © 2020 Loggia, Attoh-Mensah, Pothier, Morello, Lescure, Bocca, Marcelli and Chavoix http://creativecommons.org/licenses/by/4.0/ This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Pharmacology
Loggia, Gilles
Attoh-Mensah, Elpidio
Pothier, Kristell
Morello, Rémy
Lescure, Pascale
Bocca, Marie-Laure
Marcelli, Christian
Chavoix, Chantal
Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility
title Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility
title_full Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility
title_fullStr Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility
title_full_unstemmed Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility
title_short Psychotropic Polypharmacy in Adults 55 Years or Older: A Risk for Impaired Global Cognition, Executive Function, and Mobility
title_sort psychotropic polypharmacy in adults 55 years or older: a risk for impaired global cognition, executive function, and mobility
topic Pharmacology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7002919/
https://www.ncbi.nlm.nih.gov/pubmed/32082159
http://dx.doi.org/10.3389/fphar.2019.01659
work_keys_str_mv AT loggiagilles psychotropicpolypharmacyinadults55yearsorolderariskforimpairedglobalcognitionexecutivefunctionandmobility
AT attohmensahelpidio psychotropicpolypharmacyinadults55yearsorolderariskforimpairedglobalcognitionexecutivefunctionandmobility
AT pothierkristell psychotropicpolypharmacyinadults55yearsorolderariskforimpairedglobalcognitionexecutivefunctionandmobility
AT morelloremy psychotropicpolypharmacyinadults55yearsorolderariskforimpairedglobalcognitionexecutivefunctionandmobility
AT lescurepascale psychotropicpolypharmacyinadults55yearsorolderariskforimpairedglobalcognitionexecutivefunctionandmobility
AT boccamarielaure psychotropicpolypharmacyinadults55yearsorolderariskforimpairedglobalcognitionexecutivefunctionandmobility
AT marcellichristian psychotropicpolypharmacyinadults55yearsorolderariskforimpairedglobalcognitionexecutivefunctionandmobility
AT chavoixchantal psychotropicpolypharmacyinadults55yearsorolderariskforimpairedglobalcognitionexecutivefunctionandmobility