Article thumbnail

Cognitive toxicity of drugs used in the elderly

By Lisa L. von Moltke, David J. Greenblatt, Myroslava K. Romach and Edward M. Sellers

Abstract

The aged are an extremely heterogeneous population that is growing worldwide, included are healthy and agile individuals in their early sixties, as well as an increasing number of people over the age of 35. Pharmacotherapy is expected to continue its prominent role in the medical management of a wide range of conditions that affect older people. Adverse consequences of all kinds complicate the use of medications, and such events seem to increase in incidence with polypharmacy. Cognitive impairment can occur during the course of treatment with a wide range of medications and can have a variety of presentations, Both the number of concurrent medications that older individuals routinely use and physiologic changes in these patients render them more susceptible to developing cognitive toxicity. Most of the frequently implicated medications carry documentation of their ability to cause cognitive disturbances in their package labeling, suggesting that the level of vigilance for adverse effects during the course of their use should always be high. Such caution can be used to guide appropriate drug treatment of the aged so that clinicians do not need to opt for undertreatment to avoid toxicity

Topics: Pharmacological Aspects
Publisher: Les Laboratoires Servier
OAI identifier: oai:pubmedcentral.nih.gov:3181655
Provided by: PubMed Central

To submit an update or takedown request for this paper, please submit an Update/Correction/Removal Request.

Suggested articles

Citations

  1. (1998). A preliminary assessment of the medical and functional factors associated with vehicle crashes by older adults.
  2. (1995). Absence of the mdr1a P-glycoprotein in mice affects tissue distribution and pharmacokinetics of dexamethasone, digoxin, and cyclosporin A. J Clin Invest.
  3. Adverse drug reactions among inpatients in a north Indian referral hospital.
  4. Adverse drug reactions associated with global cognitive impairment in elderly persons.
  5. Adverse drug reactions in the elderly: need for dedicated databases.
  6. Adverse drug reactions to selegiline: a review of the French pharmacovigilance database.
  7. Age and gender effects on chlordiazepoxide kinetics: relation to antipyrine disposition.
  8. (1996). Aging into the 21st century: demographic changes.
  9. (1997). Alprazolam in young and elderly men: sensitivity and tolerance to psychomotor, sedative and memory effects. J Pharmacol Exp Ther.
  10. Alzheimer’s, ageing and amyloid: an absurd allegory?
  11. (1994). Amantadine, rimantadine prophylaxis of influenza A in nursing homes. A tolerability perspective. Drugs Aging.
  12. (1997). Antibiotics: neuropsychiatric effects and psychotropic interactions. Harv Rev Psychiatry.
  13. Antidepressants in the elderly: challenges for study design and their interpretation.
  14. (1995). Benzodi-azepine use as a cause of cognitive impairment in elderly hospital inpatients. J Gerontol A Biol Sci Med Sci.
  15. (1993). Benzodiazepine/Driving” Collaborative Group. Are benzodiazepines a risk factor for road accidents? Drug Alcohol Depend.
  16. (1993). Carisoprodol (Soma): a new and cautious perspective on an old agent.
  17. (1993). Clinical pharmacokinetics of antidepressants in the elderly: therapeutic implications. Clin Pharmacokinet.
  18. (1991). Clinical pharmacokinetics of anxiolytics and hypnotics in the elderly: therapeutic considerations (Part I). Clin Pharmacokinet.
  19. (1991). Clinical pharmacokinetics of anxiolytics and hypnotics in the elderly: therapeutic considerations (Part II). Clin Pharmacokinet.
  20. (1999). Cognitive effects of paroxetine in older depressed patients. J Clin Psychiatry.
  21. (1990). Cognitive impairment associated with betablockade in the elderly. Postgrad Med J.
  22. (1992). cost overdose: growth in drug spending for the elderly,
  23. (2001). Delirium and dementia.
  24. (1997). Diagnosis and treatment of depression in late life.
  25. Differential pharmacokinetics of digoxin in elderly patients. Drugs Aging.
  26. Drug disposition in old age.
  27. (1983). Drug metabolism in the elderly: confounding of age, smoking, and ethanol effects. Drug Metab Rev.
  28. Drug transporters in psychopharmacology—are they important?
  29. (1991). Drug treatment as a cause of falls in old age: a review of the offending agents. Drugs Aging.
  30. (1999). Drug-induced cognitive impairment in the elderly. Drugs Aging.
  31. (1997). Drug-induced depression. Psychother Psychosom.
  32. Effect of aging on the incidence of digoxin toxicity.
  33. (1996). Elevated serum digoxin levels in a patient taking digoxin and Siberian ginseng. Can Med Assoc
  34. (1999). Epidemiology of adverse drug reactions in the elderly by drug class. Drugs Aging.
  35. (1998). Epidemiology of medication-related falls and fractures in the elderly. Drugs Aging.
  36. (1990). Hepatic drug metabolism and aging. Clin Pharmacokinet.
  37. Hypnotic drugs, psychomotor performance and aging.
  38. Identification of medications that cause cognitive impairment in older people: the case of oxybutynin chloride.
  39. (1998). Interferon alpha-induced depression in chronic hepatitis C patients: comparison between different types of interferon alpha.
  40. (1993). Interventions to reduce drug-related reactions among communityresident elderly Medicare and Medicaid patients.
  41. John's wort and antidepressant drug interactions in the elderly.
  42. (1998). Ketoconazole inhibition of triazolam and alprazolam clearance: differential kinetic and dynamic consequences. Clin Pharmacol Ther.
  43. Kinetics and dynamics of psychotropic drugs in the elderly. In:
  44. Lidocaine and psychotic reactions.
  45. Long-term codeine use is associated with depressive symptoms.
  46. Lowered serum dipeptidyl peptidase IV activity is associated with depressive symptoms and cytokine production in cancer patients receiving interleukin-2-based immunotherapy.
  47. Man in’t Veld AJ, van der Cammen TJ. Contribution of adverse drug reactions to hospital admission of older patients.
  48. Management of drug therapy in the elderly.
  49. (1999). Medicinal herbs in the United States: research needs. Environ Health Perspect.
  50. (1997). Minimal effects of dextroamphetamine on scopolamine-induced cognitive impairments in humans. Biol Psychiatry.
  51. (1998). Mortality hazard associated with prescription hypnotics. Biol Psychiatry.
  52. Neurologic side effects of fluoroquinolones. Apropos of 9 cases concerning pefloxacin [In French].
  53. (1997). Neuropsychiatric adverse effects of antiparkinsonian drugs. Characteristics, evaluation and treatment. Drugs Aging.
  54. Neurotoxicity of beta-lactam antibiotics: predisposing factors and pathogenesis.
  55. (1996). Neurotoxicity of carbapenem antibacterials. Drug Saf.
  56. Neurotransmission in the aging central nervous system.
  57. (1994). Neurotransmitter receptor plasticity in aging. Life Sci.
  58. (1996). Opioid analgesic drugs in the elderly. Clin Geriatr Med.
  59. (1995). Parkinson's disease: druginduced psychiatric states. Adv Neurol.
  60. (1998). Pharmacokinetic and pharmacodynamic changes in the elderly: clinical implications. Clin Pharmacokinet.
  61. (1999). Pharmacokinetics of psychotropic drugs in the elderly. Ann Rev Gerontol Geriatr.
  62. Polypharmacy among older men in South Wales.
  63. (1998). Population ageing—a public health challenge. Fact Sheet No 135. Geneva, Switzerland: World Health Organization.
  64. Prescription and nonprescription drug use among at-risk community-dwelling seniors in Ottawa-Carleton.
  65. (2000). Profile of older Americans:
  66. (1997). Psychiatric adverse effects of anticonvulsant drugs: incidence and therapeutic implications. CNS Drugs.
  67. (1994). Psychoactive medications and injurious motor vehicle collisions involving older drivers.
  68. (1999). Psychopharmaka und Fahrtauglichkeit bei alteren Patienten.
  69. Psychotropic drug metabolism in old age: principles and problems of assessment.
  70. Psychotropic drugs and falls: new evidence pertaining to serotonin reuptake inhibitors.
  71. (1995). Psychotropic drugs and risk of recurrent falls in ambulatory nursing home residents.
  72. (1998). Psychotropic drugs and the aging patient. Geriatrics.
  73. Relations among chronic medical conditions, medications, and automobile crashes in the elderly: a population-based case-control study.
  74. Reversible steroid dementia in patients without steroid psychosis.
  75. (1991). Sensitivity to triazolam in the elderly.
  76. (1998). Single-dose pharmacokinetics and pharmacodynamics of alprazolam in elderly and young subjects.
  77. Steroid-induced psychiatric syndromes. A report of 14 cases and a review of the literature.
  78. (2000). Still rising: drug price increases for seniors 1999-2000. Washington DC: Families USA Foundation. Publication 00-103.
  79. (1985). Systemic side effects associated with the ophthalmic administration of timolol. Drug Intell Clin Pharm.
  80. (2000). Testimony on medical errors: understanding adverse drug events.
  81. (2000). The Elderly's Experiences with Health Care in Five Nations.
  82. (1999). The epidemiology of serious adverse drug reactions among the elderly. Drugs Aging.
  83. The use of non-prescription sleep products in the elderly.
  84. (1996). The use of sedative/hypnotic medication and its correlation with falling down in the hospital.
  85. (1995). Tolerability of fluoroquinolone antibiotics. Past, present and future. Drug Safety.
  86. Use of prevalence and incidence measures to describe age-related prescribing of antidepressants with and without anticholinergic effects.
  87. Visual hallucinations and delirium during treatment with amantadine (Symmetrel).