This systematic review included 13 heterogeneous studies evaluating the impact of medication optimisation or pharmacological interventions (excluding single-drug trials) on cognitive function. |
Most of the studies did not include medication optimisation (e.g., listing approaches) as an intervention, but used pharmacological interventions instead. |
Five of the trials showed a positive impact on aspects of cognitive function. |
Overall, there are few high-quality studies evaluating the impact of medication optimisation or drug interventions on cognitive functioning. |
The improvement of cognitive function by these interventions should be addressed in future pharmacological studies. |
1 Introduction
2 Methods
2.1 Search Strategy
2.2 Inclusion Criteria
2.3 Exclusion Criteria
2.4 Study Selection
2.5 Data Extraction and Synthesis
2.6 Measurement of Cognitive Function Considered for Study Selection and Data Extraction
3 Results
3.1 Study Selection
Total number of trials | Number of study participants | Number of trials on pharmacological interventions#/number of trials utilising medication optimisation## | Number of trials with positive outcome(s) | Number of studies with a Jadad score* of 3 or above | |
---|---|---|---|---|---|
Interventional trials with aspects (1–2 tests) of cognitive function | 3 | 498 | 1 2 | 0 | 1 |
Interventional trials with a comprehensive$ testing of cognitive function | 10 | 3159 | 7 3 | 5 | 6 |
Number of cognitive tests | Number of studies (thereof pharmacological interventions) | Number of studies with positive outcome (thereof pharmacological interventions) | Intervention(s) and cognitive tests (underlined and in italics) used in the studies without impact (separated by a semicolon) | Intervention(s) and cognitive tests (underlined and in italics) used in the studies with positive outcome (separated by a semicolon) |
---|---|---|---|---|
1-2 | 3 (1) | 0 (−) | A multi-component intervention including medication review and recommendations to primary care providers regarding discontinuing or reducing medications associated with delirium, using the American Geriatrics Society Beers guidelines, versus usual care [46] Minimum Data Set Cognitive Performance Scale (MDS-CPS), Brief Interview of Mental Status (BIMS); Educational intervention for nursing staff working in the intervention wards/two 4-h interactive training sessions based on constructive learning theory to recognise harmful medications and adverse drug events [47] Verbal fluency and clock drawing tests; One group was treated with antioxidant formula F at a dose of one ampule/day in the morning immediately before breakfast [48] MMSE II and a three-point scale for sleeping; | – |
3 or more tests | 10 (7) | 5 (4) | In a parallel group design participants were randomised to receive 24 weeks of treatment with daily oral doses of 1000 mg cobalamin, a combination of 1000 mg cobalamin and 400 mg folic acid, or placebo [40] A neuropsychological test battery including MMSE; The intervention involved consultation and treatment by a psychiatrist and follow-up by a research nurse and the patient’s family physician [41] Hamilton Depression Rating Scale (HAMD), the Medical Outcomes 36-item Short Form (SF-36), the Diagnostic Interview Schedule (DIS), MMSE; Oral oestradiol 1mg daily and norethisterone 0.5 mg daily or placebo [45] Dementia Rating Scale, MMSE, Word List Memory, constructional praxis, Wechsler Adult Intelligence Scale–Digit Symbol-Coding, Trail Making Test, Part Al; Modified Consortium to Establish a Registry for AD (CERAD) Boston Naming Test; Single Multidisciplinary Multistep Medication Review (3MR) [50]. MMSE, Neuropsychiatric Inventory–Nursing Home Version (NPI-NH); Discontinuation of antihypertensive medications [51]. MMSE & overall cognition (compound score): computed if 5 of the following 6 tests were available: Stroop Colour Word Test and Trail Making Test for executive functioning, 15-Word Verbal Learning Test and Visual Association Test for (immediate and delayed) verbal and picture memory and Letter-Digit Substitution Test for psychomotor speed | Patients were withdrawn from their usual antiparkinsonian medications. On 3 consecutive days, they took 0.2 mg/kg oral methylphenidate or placebo followed 30 minutes later by a 1-h intravenous L-Dopa (2 mg/kg/h) or placebo infusion [39] Simple reaction time and choice reaction time Stroop test, covert orienting of spatial attention, and digit ordering. Self-assessed mood, anxiety, arousal or concentration; Four component intervention: exercise training, intake of high protein nutritional shakes, memory training, and medication review. Control group received standard care. Both groups were also given counselling regarding dietary habits, lifestyle recommendations, and domestic hazards [49] Neuropsychological performance as measured by Short and Medium-Term Verbal Memory, Animal Naming Test, evocation of words beginning with one explicit letter, designation of famous people’s names, Verbal designation of images and verbal abstraction of word pairs; Concurrent treatment with a AChEI and either folic acid (1 mg capsule) or placebo [42] Response according to the NICE criteria, MMSE, DSST, and IADL and Social Behaviour (SB) subscales of NOSGER; Treatment with Quetiapine (25–200 mg) or haloperidol (0.5– mg) in addition to cholinesterase inhibitors [43]. NPI, CERAD neuropsychological test battery (which included the following tests: verbal fluency, modified Boston Naming Test, MMSE, constructional praxis and recall, word-list memory, word-list recognition and recall), NOSGER; Oral tamoxifen 20 mg per day or oral raloxifene 60 mg per day [44] A cognitive test battery: Global cognition screening, verbal knowledge, verbal fluency, memory (figural and verbal), attention and working memory, spatial ability, fine motor speed |