ArticleEuropean journal of clinical pharmacology2026
Does the drug accelerate the decline, or the decline invite the drug? Reverse causation in studies of inappropriate medications and dementia progression.
Article in European journal of clinical pharmacology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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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.
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Abstract
In a recent retrospective cohort from Norwegian memory clinics, Kersten and colleagues reported that potentially inappropriate medications for people with cognitive disorders were associated with faster two-year progression of mild cognitive impairment and dementia. We note that this progression signal was confined to exposure measured at the end of follow-up, was absent at baseline, and did not survive multivariable adjustment, a pattern more consistent with reverse causation and confounding by indication than with a drug effect. We further suggest that a simple count of inappropriate medications be refined through burden-weighted and class-specific analyses. Anchoring exposure temporally, applying negative control outcomes or target-trial emulation, and pursuing pragmatic deprescribing trials would help separate genuine drug effects from the clinical trajectory that drives prescribing.
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