Lessons from the STOPPCog criteria: prevalence of potentially inappropriate medications for cognition and their...

Potentially inappropriate medications (PIMs), are common among residents of long-term care institutions (LTCIs) and may contribute to cognitive impairment (CIm). STOPPCog criteria, developed in 2025, support the identification of PIMs relevant to cognition and accuracy of dementia treatment.

The study aimed to identify PIMs according to the STOPPCog criteria among residents of long-term care institutions in Poland, and to assess the association between CIm and exposure to specific drug classes.

This is a multicenter cross-sectional study in four LTCIs. Medication lists were reviewed using STOPPCog criteria and anticholinergic burden scales. Cognitive status was assessed with the Mini-Mental State Examination (MMSE), and CIm was defined using a conventional cut-off. We compared exposure frequencies between residents with and without CIm and explored factors associated with MMSE using regression models adjusted for key demographic and clinical variables and facility effects.

Of 204 residents, 133 (65.2%) had at least one STOPPCog-listed medication on their medication list. Drugs with anticholinergic burden (ACB) (54.9%), especially one subgroup - antipsychotics (39.2%), were most frequently used within the study sample. Antipsychotics were the only drug class significantly associated with CIm independently of sex, age, comorbidity burden, and facility (p < 0.001). The majority of residents with a previous diagnosis of dementia in their medical records and consequently dementia-specific pharmacotherapy had severe CIm.

There is a high prevalence of PIMs among LTCIs residents. Antipsychotic deprescribing and early diagnosis of CIm should be further evaluated in future prospective studies and clinical practice.