Potentially inappropriate medications related to two-year progression of mild cognitive impairment and dementia

PURPOSE: To document use and impact of potentially inappropriate medications on two-year progression of dementia in individuals with cognitive declines. METHODS: A retrospective study of 397 patients with Mild Cognitive Impairment (MCI) or dementia diagnosed and followed-up in outpatient memory clinics in Norway during 2009 − 18. Beers (2019)- and STOPP-2 criteria were used to identify Potentially Inappropriate Medications (PIMcogs) in individuals with cognitive impairments at baseline and two-year-follow-up. PIMcog use in terms of dementia severity, cognitive function, and neuropsychiatric and depressive symptoms were analyzed in regression models. RESULTS: The prevalence of PIMcogs increased from 16% at baseline to 23% at follow-up. PIMcog users were more likely to be women (63.5%), and they used more drugs, with a median of 5 drugs at baseline and 4 drugs at follow-up, compared to non-users who had a median of 3 used drugs at both time points. PIMcog users had higher median Neuropsychiatric Inventory severity sum scores (6 [3.0–11.0] versus 4.0 [2.0–7.0]) and median Cornell Scale for Depression in Dementia scores (6.5 [3.0–11.0] versus 4.0 [1.0–7.0]) compared to non-users at follow-up (p ≤ 0.002). PIMcog users exhibited more severe dementia, with a Clinical Dementia Rate-Sum of Boxes (CDR-SB) score of 7.0 (4.0–13.0) compared to 6.0 (3.5–10.0) in non-users. The median annual increase in CDR-SB was one unit, and PIMcog use at follow-up was significantly associated with more rapid progression of dementia severity. CONCLUSION: Faster dementia progression was documented among PIMcog users although, the prevalence of PIMcogs was generally low in Norwegian memory clinic patients with cognitive impairments.