Key result
Medication cognitive burden tools largely lack clinical cutoffs, with ~82% focusing solely on anticholinergics.
Why the study?
Multiple tools exist to help identify cognitive-impairing medications, yet a comprehensive description of these tools has not been undertaken.
Systematic Review (n=11)
Existing tools for identifying cognitive-impairing medications are largely outdated or limited to anticholinergics, highlighting the need for more comprehensive and implementable tools for clinical pharmacists.
Answers are grounded in this paper and cite their sources.
Most cognitive-burden tools limit scope to anticholinergics and lack cutoffs; challenges current instruments and extends need for comprehensive pharmacist tools.
Cognitive impairment affects around 19% of community‐dwelling older adults in the United States. Pharmacists can play a significant role in identifying and deprescribing cognitive‐impairing medications through cognitive‐focused medication reviews or as part of comprehensive medication management. Multiple tools exist to help pharmacists and other practitioners identify these medications, yet a comprehensive description of these tools has not been undertaken. We searched EBSCO MEDLINE, PubMed, EMBASE, CINAHL, and PsycInfo from inception to August 4, 2023, using search terms relative to medications and cognition. Studies were included if they detailed a tool to assess the cognitive burden of a medication regimen. Abstracts and full texts were screened independently and in duplicate. Any disagreements at the level of full‐text screening were resolved by consensus. Eligible studies underwent data extraction by two authors independently and in duplicate using a data extraction form. Our search identified 13 126 articles of which only four tools were initially included. Additionally, we identified seven articles from the reference lists of excluded review articles for a final inclusion count of 11 tools. Articles were published between 2001 and 2017. Nine of 11 tools (82%) were focused solely on anticholinergic medications, while only one tool indicated a clinically relevant cutoff value and alternative medication recommendations. While there are many tools to assess the cognitive burden from medications, many are limited by the development date, focus on anticholinergic medications, or lack clinically useful information. Further research is needed to develop more comprehensive, up‐to‐date, and readily implementable tools that clinical pharmacists can utilize to assess medication‐induced cognitive risks. Such as tool could be applied by pharmacists in many settings to optimize medication use and improve patient outcomes.
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Stanton et al. (2024) conducted a systematic review in Drug-induced cognitive impairment (n=11). Tools to assess cognitive burden of medications was evaluated on Characteristics of tools to assess cognitive burden. A systematic review identified 11 tools to assess medication cognitive burden, of which 82% focused solely on anticholinergics and only one provided a clinical cutoff and alternative recommendations.
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