title: Influence of central nervous system-acting drugs on results of cognitive testing in geriatric inpatients.
abstract: BACKGROUND
  Growing evidence shows a high correlation between extensive use of central nervous system-acting drugs (CNSADs) in elderly patients and adverse drug reactions (ADRs) such as falls, fractures, and mortality.
  
  
  OBJECTIVE
  Are results of cognitive testing with the Mini Mental Status Examination (MMSE) influenced by use of CNSADs?
  
  
  METHODS
  Geriatric inpatient service for acute, subacute, and rehabilitation care.
  
  
  METHODS
  Secondary combined analysis of two prospective, single-center study cohorts (PROPSYC, 2011 and AGE OUT, 2012) with identical procedure for the MMSE at a tertiary hospital.
  
  
  RESULTS
  Overall, 395 patients were included, 144 male (M) and 251 female (F). Mean age was 80.0 ± 8.4 years (M 76.7 ± 9.1, F 81.9 ± 7.3, p = 0.0000). Mean MMSE points were 22.9 ± 4.8 (M 23.2 ± 4.6, F 22.6 ± 5.0, p = 0.211). In total, 258 patients (65.3 %) used drugs with potential adverse cognitive properties. Analgesics with central activity were given to 117 of 395 patients (29.6 %). Low-potency opioids (tramadol hydrochloride, tilidine) were identified in 60 patients and high-potency opioids in 57 patients. Antidepressants were used in 66 patients, benzodiazepines in 26, and hypnotics in 11, while 38 patients received other CNSADs. We only found significant correlations with the results of cognitive testing for sedatives (diazepam and oxazepam, Pearson's r - 0.79, p = 0.05), but not for lorazepam.
  
  
  CONCLUSIONS
  Our analysis shows an influence of sedatives (diazepam and oxazepam, but not lorazepam) on cognitive testing with the MMSE in users of CNSADs.
authors.affiliation: Department of Geriatrics, Lindenbrunn Hospital, Lindenbrunn 1, 31863, Coppenbrügge, Germany, gogol@krankenhaus-lindenbrunn.de.
authors.forename: M
authors.initials: M
authors.lastname: Gogol
authors.forename: H
authors.initials: H
authors.lastname: Hartmann
authors.forename: S
authors.initials: S
authors.lastname: Wustmann
authors.forename: A
authors.initials: A
authors.lastname: Simm
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000701:Analgesics, Opioid / Q000009:adverse effects / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects / Q000627:therapeutic use; D002491:Central Nervous System Agents / Q000009:adverse effects* / Q000627:therapeutic use; D003072:Cognition Disorders / Q000139:chemically induced* / Q000175:diagnosis; D003975:Diazepam / Q000009:adverse effects / Q000627:therapeutic use; D005260:Female; D006760:Hospitalization; D006801:Humans; D006993:Hypnotics and Sedatives / Q000009:adverse effects / Q000627:therapeutic use; D008140:Lorazepam / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D008609:Mental Status Schedule; D010076:Oxazepam / Q000009:adverse effects / Q000627:therapeutic use
chemical_list: D000701:Analgesics, Opioid; D000928:Antidepressive Agents; D002491:Central Nervous System Agents; D006993:Hypnotics and Sedatives; D001569:Benzodiazepines; D010076:Oxazepam; D008140:Lorazepam; D003975:Diazepam
references.citation: JAMA. 2001 Apr 25;285(16):2081
references.pmid: 11311096
references.citation: J Sleep Res. 2005 Sep;14(3):311-7
references.pmid: 16120107
references.citation: Clin Interv Aging. 2008;3(2):273-8
references.pmid: 18686750
references.citation: N Engl J Med. 2009 Nov 26;361(22):2105-7
references.pmid: 19940297
references.citation: J Pain. 2011 Mar;12(3 Suppl 1):S21-9
references.pmid: 21396598
references.citation: Sleep. 2012 Sep 01;35(9):1201-7
references.pmid: 22942498
references.citation: J Am Geriatr Soc. 2009 Feb;57(2):243-50
references.pmid: 19207141
references.citation: Br J Gen Pract. 2004 Dec;54(509):919-21
references.pmid: 15588537
references.citation: J Am Geriatr Soc. 2010 Jul;58(7):1353-69
references.pmid: 20533971
references.citation: JAMA. 2010 May 26;303(20):2020-1
references.pmid: 20501919
references.citation: J Am Geriatr Soc. 2014 Feb;62(2):336-41
references.pmid: 24417438
references.citation: J Psychiatr Res. 1975 Nov;12(3):189-98
references.pmid: 1202204
references.citation: Sleep Med. 2010 Apr;11(4):372-7
references.pmid: 20219426
references.citation: PLoS Med. 2008 Jan 8;5(1):e12
references.pmid: 18184033
references.citation: Brain. 2011 Jun;134(Pt 6):1623-34
references.pmid: 21427462
references.citation: J Forensic Sci. 2005 Jan;50(1):192-5
references.pmid: 15831018
references.citation: Drugs Aging. 2007;24(12):1045-59
references.pmid: 18020536
references.citation: Clin Ther. 2006 Oct;28(10):1695-700
references.pmid: 17157125
references.citation: BMJ. 2014 Feb 19;348:g1393
references.pmid: 24553363
references.citation: PLoS One. 2014 Mar 12;9(3):e91251
references.pmid: 24622163
references.citation: Pharmacoepidemiol Drug Saf. 2009 Oct;18(10):916-22
references.pmid: 19585466
references.citation: Circulation. 2010 Jan 26;121(3):384-91
references.pmid: 20065160
references.citation: Osteoporos Int. 2013 Feb;24(2):671-80
references.pmid: 22669469
references.citation: Arch Intern Med. 2010 Sep 13;170(16):1425-32
references.pmid: 20837827
references.citation: Am J Geriatr Pharmacother. 2008 Aug;6(3):147-52
references.pmid: 18775389
references.citation: J Am Geriatr Soc. 2014 Jan;62(1):25-39
references.pmid: 24383523
references.citation: JAMA Intern Med. 2014 May;174(5):796-801
references.pmid: 24589873
references.citation: J Am Geriatr Soc. 1999 Jan;47(1):30-9
references.pmid: 9920227
references.citation: Am J Geriatr Pharmacother. 2007 Dec;5(4):317-23
references.pmid: 18179989
references.citation: Int Psychogeriatr. 2010 Feb;22(1):114-9
references.pmid: 19552831
references.citation: Arch Intern Med. 2010 Dec 13;170(22):1968-76
references.pmid: 21149752
references.citation: J Am Geriatr Soc. 2010 Sep;58(9):1664-70
references.pmid: 20863326
references.citation: JAMA. 2008 Dec 10;300(22):2613-20
references.pmid: 19066381
references.citation: J Am Geriatr Soc. 2011 Aug;59(8):1412-20
references.pmid: 21824120
references.citation: Ann Intern Med. 2011 Sep 6;155(5):325-8
references.pmid: 21893626
references.citation: Psychosomatics. 2002 Jan-Feb;43(1):31-5
references.pmid: 11927755
references.citation: Am J Geriatr Pharmacother. 2006 Dec;4(4):380-94
references.pmid: 17296542
references.citation: J Am Geriatr Soc. 2011 Sep;59(9):1575-80
references.pmid: 21883110
references.citation: N Engl J Med. 2008 May 29;358(22):2400-2
references.pmid: 18509126
references.citation: J Am Geriatr Soc. 2007 Oct;55 Suppl 2:S403-8
references.pmid: 17910563
references.citation: J Am Geriatr Soc. 2011 Aug;59(8):1421-8
references.pmid: 21797836
references.citation: Arch Intern Med. 2009 Sep 14;169(16):1476-83
references.pmid: 19752405
references.citation: Dement Geriatr Cogn Dis Extra. 2012 Jan;2(1):57-68
references.pmid: 22619661
references.citation: J Am Geriatr Soc. 2014 Jan;62(1):47-53
references.pmid: 25093233
references.citation: Br J Clin Pharmacol. 2005 Feb;59(2):143-51
references.pmid: 15676035
references.citation: Int Psychogeriatr. 2012 Jan;24(1):48-54
references.pmid: 21843400
references.citation: Ann Intern Med. 2010 Jan 19;152(2):85-92
references.pmid: 20083827
references.citation: Am J Psychiatry. 2011 Aug;168(8):831-9
references.pmid: 21572163
references.citation: BMJ. 2012 Aug 29;345:e5568
references.pmid: 22936786
references.citation: Arch Intern Med. 2010 Dec 13;170(22):1979-86
references.pmid: 21149754
references.citation: JAMA. 2014 Feb 19;311(7):682-91
references.pmid: 24549548
references.citation: J Am Geriatr Soc. 2014 Jan;62(1):16-24
references.pmid: 24417410
references.citation: Pain Pract. 2008 Jul-Aug;8(4):287-313
references.pmid: 18503626
references.citation: Am J Geriatr Pharmacother. 2010 Oct;8(5):460-71
references.pmid: 21335299
references.citation: Lancet. 1999 Oct 9;354(9186):1248-52
references.pmid: 10520633
references.citation: Eur J Pain. 2005 Aug;9(4):453-62
references.pmid: 15979026
references.citation: PLoS One. 2013 Dec 09;8(12):e81877
references.pmid: 24349147
references.citation: J Clin Oncol. 2011 Apr 1;29(10):1297-303
references.pmid: 21357785
references.citation: J Am Geriatr Soc. 2009 Aug;57(8):1331-46
references.pmid: 19573219
references.citation: MMWR Morb Mortal Wkly Rep. 2010 Jun 18;59(23):705-9
references.pmid: 20559200
references.citation: J Am Geriatr Soc. 2014 Feb;62(2):358-64
references.pmid: 24417590
references.citation: Int J Neuropsychopharmacol. 2008 May;11(3):381-8
references.pmid: 17697395
references.citation: JAMA. 2011 Apr 6;305(13):1315-21
references.pmid: 21467284
references.citation: PLoS One. 2014 Mar 03;9(3):e89317
references.pmid: 24595096
references.citation: J Am Geriatr Soc. 2011 Mar;59(3):430-8
references.pmid: 21391934
references.citation: J Clin Pharm Ther. 2006 Dec;31(6):593-8
references.pmid: 17176364
references.citation: N Engl J Med. 2011 Nov 24;365(21):2002-12
references.pmid: 22111719
references.citation: Am J Geriatr Pharmacother. 2006 Sep;4(3):227-35
references.pmid: 17062323
references.citation: JAMA Intern Med. 2013 Feb 11;173(3):196-201
references.pmid: 23318919
references.citation: Clin Interv Aging. 2013;8:1471-82
references.pmid: 24204133
references.citation: MMWR Morb Mortal Wkly Rep. 2009 Oct 30;58(42):1171-5
references.pmid: 19875978
references.citation: BMC Geriatr. 2011 Nov 01;11:70
references.pmid: 22044595
references.citation: Clin Pharmacol Ther. 2008 Oct;84(4):462-7
references.pmid: 19238650
references.citation: J Gerontol A Biol Sci Med Sci. 1995 Mar;50(2):M99-106
references.pmid: 7874596
references.citation: Neurology. 2012 Oct 23;79(17):1802-8
references.pmid: 23091073
references.citation: Int J Geriatr Psychiatry. 2012 Dec;27(12):1248-57
references.pmid: 22374884
references.citation: J Gerontol A Biol Sci Med Sci. 2009 Apr;64(4):492-8
references.pmid: 19196642
references.citation: Arch Intern Med. 2011 Apr 11;171(7):686-91
references.pmid: 21482846
references.citation: J Am Geriatr Soc. 2003 Apr;51(4):534-8
references.pmid: 12657075
references.citation: N Engl J Med. 2010 Nov 18;363(21):1981-5
references.pmid: 21083382
references.citation: PLoS One. 2012;7(8):e44239
references.pmid: 22937167
references.citation: Eur J Clin Pharmacol. 2011 Jul;67(7):731-9
references.pmid: 21298261
references.citation: Alzheimers Dement. 2011 May;7(3):280-92
references.pmid: 21514248
references.citation: Sleep. 2012 Apr 01;35(4):491-9
references.pmid: 22467987
references.citation: J Pain. 2011 Mar;12(3 Suppl 1):S14-20
references.pmid: 21296028
references.citation: Arch Intern Med. 2009 Nov 23;169(21):1952-60
references.pmid: 19933955
references.citation: Osteoporos Int. 2006;17(6):807-16
references.pmid: 16520889