Potentially inappropriate medications and cognitive performance: cross-sectional results from the ELSA-Brasil study

Eur J Clin Pharmacol. 2023 Jul;79(7):927-934. doi: 10.1007/s00228-023-03504-5. Epub 2023 May 10.


Objectives: Potentially inappropriate medications (PIM), especially those with potential effects on the central nervous system, can increase the risk of cognitive impairment. We investigated the association of the use of PIM and PIM that may impair cognition (PIM-Cog) with cognitive performance among older adults.

Methods: In this cross-sectional study with 2,626 participants, PIM and PIM-Cog were defined by the 2019 American Geriatrics Society Beers criteria. We calculated global cognition and memory, verbal fluency, and Trail Making Test B version (TMT-B) z-scores. Linear regression models adjusted for sociodemographic and clinical variables were used to investigate the association between PIM and cognition.

Results: 27% and 7% of the sample (mean age = 65.1 ± 4.1 years old, 54% women, and 61% White) used at least one PIM and PIM-cog, respectively. PIM was associated with poor performance in the TMT-B (β = -0.17, 95% Cl = -0.29; -0.05, p = 0.007). PIM-Cog was also associated with poor TMT-B performance (β = -0.08, 95% Cl = -0.15; -0.01, p = 0.025).

Conclusion: The use of PIM and PIM-Cog was associated with poor executive function among older adults. The review of PIM use and the deprescription of these drugs may be an effective way to improve cognitive function.

Keywords: Cognition; Dementia; Drug utilization; Inappropriate; Medication; Potentially.

MeSH terms

  • Aged
  • Cognition
  • Cognitive Dysfunction* / chemically induced
  • Cross-Sectional Studies
  • Female
  • Humans
  • Inappropriate Prescribing
  • Male
  • Middle Aged
  • Potentially Inappropriate Medication List*
  • United States