title: Polypharmacy Cut-Off for Gait and Cognitive Impairments.
abstract: BACKGROUND
  Polypharmacy is a well-established risk factor for falls, and these are one of the major health problems that affect the quality of life as people age. However, the risk of mobility and cognitive impairments consecutive to polypharmacy has been little addressed, despite the association between these adverse outcomes and falls. Moreover, the rare polypharmacy cut-offs were all but one arbitrarily determined.
  
  
  OBJECTIVE
  Studying relationships between polypharmacy and both mobility and cognitive impairments, and statistically determining a cut-off point in the number of medicinal molecule beyond which polypharmacy has deleterious consequences with respect to mobility and cognitive impairment.
  
  
  METHODS
  We enrolled 113 community-dwelling adults aged 55 years and older with a fall history, with or without injury, in the previous year. We carefully collected information about daily medicinal molecules taken. We assessed basic mobility and global cognition with the Time-Up-and-Go and the Montreal Cognitive Assessment (MoCA) test, respectively (clinicaltrials.gov NCT02292316).
  
  
  RESULTS
  Timed-Up and Go test and MoCA scores were both significantly correlated with the number of molecule, used. Receiver Operating Characteristic curves indicate, with high prediction (p < 0.002), that daily consumption of five or more molecules is associated with risk for both impaired mobility and global cognition. These relationships were independent of the number of comorbidities and of the pharmacological class.
  
  
  CONCLUSIONS
  Community-dwelling adults aged 55 years and older who take five or more daily medicinal molecules are at high risk for both mobility and cognitive impairments. Physicians and patients should be aware of these new findings, especially when there are multiple prescribers involved in the care of the patient.
authors.affiliation: Normandie Université, Université de Caen Normandie, Institut National de la Santé et de la Recherche Médicale, COMETE Caen, France.
authors.forename: Antoine
authors.initials: A
authors.lastname: Langeard
authors.affiliation: Normandie Université, Université de Caen Normandie, Institut National de la Santé et de la Recherche Médicale, COMETE Caen, France.
authors.forename: Kristell
authors.initials: K
authors.lastname: Pothier
authors.affiliation: Centre Hospitalier Universitaire de Caen, Departments of Statistics and Clinical Research, Normandie Université, Université de Caen Normandie Caen, France.
authors.forename: Remy
authors.initials: R
authors.lastname: Morello
authors.affiliation: Centre Hospitalier Universitaire de Caen, Departments of Pharmacology, Normandie Université, Université de Caen Normandie Université, Institut National de la Santé et de la Recherche Médicale, COMETE Caen, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Lelong-Boulouard
authors.affiliation: Centre Hospitalier Universitaire de Caen, Departments of Geriatrics, Normandie Université, Université de Caen Normandie Université, Institut National de la Santé et de la Recherche Médicale, COMETE Caen, France.
authors.forename: Pascale
authors.initials: P
authors.lastname: Lescure
authors.affiliation: Normandie Université, Université de Caen Normandie, Institut National de la Santé et de la Recherche Médicale, COMETE Caen, France.
authors.forename: Marie-Laure
authors.initials: ML
authors.lastname: Bocca
authors.affiliation: Centre Hospitalier Universitaire de Caen, Departments of Rheumatology, Normandie Université, Institut National de la Santé et de la Recherche Médicale, COMETE Caen, France.
authors.forename: Christian
authors.initials: C
authors.lastname: Marcelli
authors.affiliation: Centre Hospitalier Universitaire de Caen, Departments of Geriatrics, Normandie Université, Université de Caen Normandie Université, Institut National de la Santé et de la Recherche Médicale, COMETE Caen, France.
authors.forename: Pablo
authors.initials: P
authors.lastname: Descatoire
authors.affiliation: Normandie Université, Université de Caen Normandie, Institut National de la Santé et de la Recherche Médicale, COMETE Caen, France.
authors.forename: Chantal
authors.initials: C
authors.lastname: Chavoix
keywords: aging; cognition; cut-off; gait; middle age; mobility; polypharmacy