Neurocognitive costs and benefits of psychotropic medications in older adults.
Psychotropic medications are widely used in older adults and may cause neurocognitive deficits. Older adults are at increased risk of developing adverse effects because of age-related pharmacodynamic and pharmacokinetic changes. This article provides a comprehensive review of the undesirable, and at times beneficial, effects of psychotropic medications. The review covers a wide range of medications that impair executive function, memory, and attention, as well as a much smaller group of medications that lead to improved neurocognitive function. Some of the most commonly used psychotropic medications in older adults, namely, antidepressants, sedatives, and hypnotics, are among the drugs that most consistently lead to cognitive impairments. Medications with anticholinergic properties almost invariably lead to neurocognitive dysfunction, despite symptom improvement. The neurocognitive costs and benefits of psychiatric medications should be considered in the context of disease treatment in older adults.
Brooks
John O
JO
Palo Alto Veterans Affairs Health Care System and Department of Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA. johnbrooks@stanford.edu
Hoblyn
Jennifer C
JC
D000367:Age Factors; D000368:Aged; D014151:Anti-Anxiety Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D014150:Antipsychotic Agents / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D001288:Attention / Q000187:drug effects; D018680:Cholinergic Antagonists / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D003072:Cognition Disorders / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D018849:Controlled Clinical Trials as Topic; D003704:Dementia / Q000097:blood / Q000139:chemically induced* / Q000188:drug therapy; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000493:pharmacokinetics / Q000627:therapeutic use; D008657:Metabolic Clearance Rate / Q000502:physiology; D011619:Psychotropic Drugs / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D012307:Risk Factors
D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D014150:Antipsychotic Agents; D018680:Cholinergic Antagonists; D006993:Hypnotics and Sedatives; D011619:Psychotropic Drugs