Which is More Important to Enhance or Deteriorate Cognitive Functions in Older Adults With Major Cognitive Impairment: The Drug Burden Index or the Total Number of Medications?

Objectives: To prevent the adverse effects, deprescribing is a structured approach aimed at reducing anticholinergic burden and improving clinical outcomes, particularly in those with cognitive impairment. The objective of this study was to ascertain the impact of alterations in the total number of medications and the Drug Burden Index (DBI) score on cognitive tests and Activity of Daily Living (ADL) scores during a 6-month follow-up period in older patients with major neurocognitive impairment. Methods: A total of 232 older patients with major neurocognitive impairment were enrolled in this study, which was retrospectively designed and followed up. The alterations in the total number of medications and the DBI scores were evaluated at baseline and at the end of the sixth month, which were compared with the changes in cognitive tests and ADL scores. Results: Comparing baseline and end-of-six-month Mini-Mental State Examination (MMSE) scores revealed a significant decrease in MMSE scores in patients with elevated DBI scores and those with increased medication intake ( P =0.001 and P =0.034, respectively). A subsequent comparison of the change in MMSE score across the groups revealed a significant decrease only among the group with decreased DBI score (Δ=0.45±3.29 and P <0.001). In the linear regression analysis, a 1-unit increase in DBI score and drug number was associated with a decrease in MMSE scores ( B : −0.245 vs. −0.197). Conclusions: The 6-month follow-up study demonstrated that deprescribing should prioritize the comprehensive evaluation of medication quantity and anticholinergic burden to enhance the efficacy of dementia care in older adults.