[Drug-induced cognitive impairment and dementia]
O D Ostroumova1, T M Ostroumova2, A I Kochetkov1
1Russian Medical Academy of Continuous Professional Education, Moscow, Russia.
Summary
Certain medications can cause or worsen cognitive impairment (CI). Identifying drug-induced CI involves linking medication use to cognitive decline, with treatment focusing on drug cessation or dose reduction.
Area of Science:
- Pharmacology
- Neurology
- Geriatrics
Background:
- Medications are a significant factor in the development or exacerbation of cognitive impairment (CI).
- Numerous drug classes, including NSAIDs, antiarrhythmics, antidepressants, and glucocorticosteroids, are implicated.
- The underlying pathophysiological mechanisms are diverse, involving hormonal disruption, altered neuronal excitability, and reduced cerebral circulation, with some mechanisms yet to be fully elucidated.
Purpose of the Study:
- To review the causes, risk factors, diagnosis, treatment, and prevention of drug-induced cognitive impairment.
- To highlight the importance of considering medication side effects in patients presenting with cognitive decline.
Main Methods:
- Literature review of studies on drug-induced cognitive impairment.
- Analysis of pathophysiological mechanisms and risk factors.
- Discussion of diagnostic and therapeutic strategies.
Main Results:
- A wide range of drugs can induce or worsen CI through various mechanisms.
- Risk factors include advanced age, pre-existing brain damage, polypharmacy, and specific patient conditions.
- Diagnosis requires correlating drug initiation with cognitive decline; treatment involves drug withdrawal or dose adjustment.
Conclusions:
- Drug-induced CI is a significant clinical concern requiring careful medication management.
- Preventive strategies include judicious drug selection, assessment of drug interactions, and utilizing risk assessment tools like the anticholinergic burden scale.
Related Concept Videos
01:30Cognitive Enhancers: Cholinesterase Inhibitors and NMDA Receptor Antagonists
121
Cognitive enhancers, also known as "smart drugs," are substances used to enhance memory, mental alertness, and concentration. These can be natural or synthetic and improve cognition in conditions like Alzheimer's disease (AD) and other neurodegenerative diseases. Some common examples include caffeine, amphetamines, methylphenidate, modafinil, arecoline, donepezil, vortioxetine, and piracetam. These enhancers work on the principle of synaptic plasticity and altered circuit function.
121
01:30Dementia
113
Dementia is a collective term for cognitive disorders primarily affecting memory, thinking, and reasoning. It is not a specific disease but a syndrome, with Alzheimer's disease being the most common cause, accounting for approximately 60-80% of cases. Other types include vascular dementia, Lewy body dementia, and frontotemporal dementia. Dementia affects millions worldwide, particularly older adults, though it is not a normal part of aging.
The progression of dementia is generally gradual....
The progression of dementia is generally gradual....
113
01:26Alzheimer's Disease: Overview
468
Alzheimer's Disease (AD) is a continually advancing neurodegenerative disorder, distinguished by escalating memory loss, cognitive dysfunction, and dementia. The disease unfolds in three stages: preclinical, mild cognitive impairment (MCI), and dementia. Its onset is insidious, and the progression gradual, with the cause not well explained by other disorders.
The clinical diagnosis of AD hinges on the presence of memory and other cognitive impairments. Biomarkers, such as changes in Aβ...
The clinical diagnosis of AD hinges on the presence of memory and other cognitive impairments. Biomarkers, such as changes in Aβ...
468
01:27CNS Depressants: Alcohol and Nicotine
205
Ethanol, a clear colorless alcohol, has been consumed by humans for millennia, but its effects on the body are far from benign. At lower doses, it induces decreased inhibitions and loquaciousness, leading to its social appeal. However, it can cause severe consequences at higher doses, such as coma and respiratory depression, due to its zero-order elimination kinetics. Chronic ethanol abuse wreaks havoc on multiple organ systems, particularly the CNS and the liver. Abrupt cessation of ethanol...
205
01:22Alzheimer's Disease: Treatment
183
Alzheimer's Disease (AD), a neurodegenerative disorder, is pathologically identified by amyloid plaques and neurofibrillary tangles composed of tau protein. AD pharmacotherapy aims to manage cognitive symptoms, delay disease progression, and treat behavioral symptoms. The treatment is primarily symptomatic and palliative, with no definitive disease-modifying therapy available. Cholinesterase inhibitors, including donepezil (Aricept), rivastigmine (Exelon), and galantamine (Razadyne), are...
183
01:24CNS Stimulants: Cocaine, Amphetamines and Cannabinoids
187
CNS stimulants, such as cocaine, amphetamines, and cannabinoids, have varying structures and mechanisms of action that lead to different therapeutic effects and side effects. Cocaine, with its molecular formula C17H21NO4, is a tropane alkaloid and a tertiary amino compound. It has two chemical forms: the hydrochloride salt and the "freebase." The former is in powder form, while the latter involves removing the hydrochloride salt to create a form that can be smoked. Cocaine exerts its...
187