Medications and cognition in older adults

Abstract

The elderly patient is particularly susceptible to negative effects on cognition that can arise from certain medications. This may occur whether or not pre-existing cognitive impairment is present. Medications whose primary target is the central nervous system (e.g., antidepressants, antipsychotics, sedative-hypnotics) or those which are targeted at other primary systems (e.g., cardiovascular drugs, urinary anti-spasmodics) should be considered as contributing factors in the patient with confusion or memory decline. Steps that can be taken to reduce this risk include: coordination of medical care among the patient's clinicians to avoid polypharmacy, judicious selection of appropriate medications, use of the lowest effective drug dose, and substitution of non-pharmacologic therapies whenever possible. This chapter addresses potential complications of medication use in older adults with cognitive decline.