Polypharmacy and Cognition Function Among Rural Adults

Article type: Research Article

Authors: Rasu, Rafia S.^{a; b; *} | Shrestha, Nistha^c | Karpes Matusevich, Aliza R.^a | Zalmai, Rana^a | Large, Stephanie^d | Johnson, Leigh^d | O’Bryant, Sid E.^d

Affiliations: [a] College of Pharmacy, Department of Pharmacotherapy, University of North Texas Health Science Center, Fort Worth, TX, USA | [b] School of Public Health, Department of Health Behavior and Health Systems, University of North Texas Health Science Center, Fort Worth, TX, USA | [c] School of Public Health, Department of Biostatistics and Epidemiology, University of North Texas Health Science Center, Fort Worth, TX, USA | [d] Graduate School of Biomedical Sciences, Department of Pharmacology and Neuroscience, University of North Texas Health Science Center, Fort Worth, TX, USA

Correspondence: [*] Correspondence to: Rafia Rasu, BPharm, MPharm, MBA, PhD, Professor of Pharmacotherapy, College of Pharmacy, The University of North Texas Health Science Center at Fort Worth, 3500 Camp Bowie Blvd, Fort Worth, TX 76107, USA. Tel.: +1 817 735 2932; Fax: +1 817 735 2603; E-mail: rafia.rasu@unthsc.edu.

Abstract: Background:Polypharmacy (using≥5 medications) is associated with poor health outcomes. Mixed results from past studies surrounding chronic medication use, control of chronic conditions, and their effects on cognitive performance warrant further attention. Objective:Investigate a link between polypharmacy and cognition function in rural-dwelling adults in Texas, USA. Methods:Project FRONTIER (Facing Rural Obstacles to Healthcare Now Through Intervention, Education & Research) is a cross-sectional epidemiological study using community-based participatory research in three counties of Texas. Residents age > 40 were eligible for inclusion. The primary outcome is cognitive impairment, and exposures of interest are polypharmacy; comorbidities; and diabetes, hypertension, and depression medication. Logistic regression was used to assess association. Results:Six hundred eighty-nine individuals participated; the mean age was 61, and the majority were female (68.7%).The median number of medications taken by participants was 3.3 (IQR: 0–5); the rate of polypharmacy was 29.6%. Anti-hypertensive agents were the most common medications (15%) used. Polypharmacy users were 2.84 times more likely to have cognitive impairment [OR: 2.84, 95%CI (1.32–6.09)] than those using < 5 medications. Participants on hypertensive medications had 1.85 times higher odds [OR: 1.85, 95%CI (1.14–3.01)] of having cognitive impairment than those who did not have cognitive impairment. Conclusion:Polypharmacy increases the odds of cognitive impairment. The odds of presenting with cognitive impairment increased as the number of medications increased. Additionally, we identified a large, concerning number of participants with pharmacotherapy and poor chronic disease management. A larger study should examine medication adherence among rural elders to manage chronic disease and any healthcare barriers to adherence.

Keywords: Antidepressants, antidiabetics, antihypertensive, cognitive impairment, cognition performance, dementia, medications, polypharmacy

DOI: 10.3233/JAD-200951

Journal: Journal of Alzheimer's Disease, vol. 82, no. 2, pp. 607-619, 2021