Impact of Beta Blockers on Memory: Systematic Review of Neuropsychological Findings

Objective: Beta-blockers (BBs) are among the most widely prescribed drugs worldwide and are cornerstone therapies in cardiovascular medicine, including the treatment of heart failure with reduced ejection fraction, coronary artery disease, arrhythmias, and hypertension. Given the central role of the noradrenergic system in memory processes and the presence of Beta-adrenergic receptors in the brain, it remains unclear whether, and which memory functions are affected by BBs. Additionally, it is unclear to what extent such effects depend on pharmacological properties such as lipophilicity and Beta-receptor selectivity. The aim of this systematic review is to summarize findings from double-blind randomized controlled trials on memory performance. Design and method: A systematic literature search was conducted in PubMed to identify double-blind randomized controlled trials investigating the effects of Beta-blockers on cognitive functions in human subjects using objective neuropsychological test measures. Results: A total of 59 randomized controlled trials were included, comprising 2,565 participants exposed to Beta-blockers. Propranolol and atenolol were most extensively studied (n = 1,461 and n = 992, respectively). Most trials assessed verbal and figural memory using standardized recall and recognition tasks (n = 38), while 15 studies examined emotional memory paradigms, four investigated stress-induced memory processes, and two focused on drug-associated memory. Overall, findings were highly heterogeneous, with significant effects reported in 33 studies. Effects were predominantly observed in single-dose studies, whereas longer-term exposure was rarely associated with relevant changes in memory performance. Memory tasks involving emotional, stress-related, or drug-associated content appeared more sensitive to Beta-adrenergic modulation than non-emotional (neutral) tasks and mainly showed attenuated memory performance. Significant effects were primarily observed with lipophilic Beta-blockers, while hydrophilic agents were rarely associated with cognitive changes. Conclusions: Overall, the findings indicate heterogeneous and context-dependent cognitive effects of Beta-blockers. Memory effects appear to reflect situation- and paradigm-specific modulation rather than global cognitive impairment. Importantly, long-term Beta-blocker therapy is not associated with clinically relevant changes in memory function.