Evidence map›Paper›PMID 36329311›Full record

Observational studyEuropean journal of clinical pharmacology2022

Potentially inappropriate medication use and mortality in patients with cognitive impairment.

Emily Buckley, Agnes Jonsson, Zoe Flood, Maria Lavelle, Noelle O'Sullivan, Nadra Nurdin, Philip Dowling, Eoin Duggan, Elizabeth Callaly, Colm Byrne and 4 more

Abstract readObservational Study
PubMed Publisher
In one paragraph

Observational study in European journal of clinical pharmacology, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
7citing papers in PubMed, 2 pooled it
1.9field-weighted citation impact, top 15% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

7 citing papers in PubMed, 2 syntheses or guidelines pooled it, 17 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
  3. Article
  4. Article
  5. Article
  6. Article
  7. Observational
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

14 authors at 2 institutions in 1 country.

Emily BuckleyDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland. emj.buckley@gmail.com.ORCID http://orcid.org/0000-0002-0708-9568
Agnes JonssonDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Zoe FloodDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Maria LavelleDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Noelle O'SullivanDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Nadra NurdinDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Philip DowlingDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Eoin DugganDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Elizabeth CallalyDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Colm ByrneDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Cora McGreevyDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Joseph DugganDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Lorraine KyneDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
John J McCabeDepartment of Geriatric Medicine, Mater Misericordiae University Hospital, Dublin, Ireland.
Mater Misericordiae University Hospital · IEUniversity College Dublin · IE

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposePotentially inappropriate medications (PIMs) are associated with falls, hospitalization, and cognitive decline. Few studies have investigated the association between PIMs related to cognitive impairment (PIMCog) and mortality in dementia or mild cognitive impairment (MCI).

methodsThis was a retrospective observational study. Patients diagnosed with MCI or dementia (DSM-IV criteria) presenting to a tertiary-referral memory clinic from 2013 to 2019 were eligible. The primary outcome was all-cause death. Secondary outcomes were vascular death and non-vascular death. The primary exposure variable of interest was PIMCog, defined as any medication in the Beers 2015 or STOPP criteria, classified as potentially inappropriate for patients with cognitive impairment. Anticholinergic burden was measured using the anticholinergic cognitive burden (ACB) scale. Polypharmacy was defined as ≥ 5 medications. Cox proportional hazard models were used to calculate hazard ratios (HRs) and 95% confidence intervals (95% CIs).

resultsFour hundred eighteen patients were included (n = 261 dementia, n = 157 MCI). The median age was 79 (interquartile range [IQR] 74-82) and median follow-up was 809 days (IQR 552-1571). One or more PIMCog was prescribed in 141 patients (33.4%). PIMCog use was associated with all-cause mortality after adjustment for age, sex, dementia severity, Charlson's Co-morbidity Index, chronic obstructive pulmonary disease, congestive cardiac failure, and peripheral vascular disease (HR 1.96, 95% CI 1.24-3.09). PIMCog use was associated with vascular death (HR 3.28, 95% CI 1.51-7.11) but not with non-vascular death (HR 1.40 95% CI 0.78-2.52).

conclusionPIMCog use in patients with cognitive impairment is high. It is independently associated with all-cause mortality and vascular death. This is a potential modifiable risk factor for death in this patient cohort. Further research is required to independently validate this finding.

Indexed as

Cognitive DysfunctionDementiaCholinergic AntagonistsHumansInappropriate PrescribingInfantPolypharmacyPotentially Inappropriate Medication ListCholinergic AntagonistsAnticholinergic burdenDementiaMortalityPolypharmacyPotentially inappropriate medications

Identifiers

PMID36329311
OpenAlexW4308181481

What OpenQuestion holds

Textmetadata
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.