A systematic review on current evidence from randomized controlled trials (RCT) on the impact of medication optimization or pharmacological interventions on quantitative measures of cognitive capacity in geriatric patients

Background Cognitive decline is common in older people. Numerous reports point to the detrimental impact of polypharmacy and inappropriate medication on older people’s cognitive capacity. Here we aim to systematically review evidence on the impact of medication optimization on cognitive capacity in older adults. Methods A systematic review was performed using MEDLINE and Web of Science. Only randomized controlled trials (RCT) addressing the impact of medication optimization or pharmacological interventions on quantitative measures of cognitive capacity in older adults (> 65 years) were included, single drug interventions (e.g. on antidementives) were excluded. The quality of the studies was assessed by using the Jadad. Results 17 studies met the inclusion criteria. In 8 studies a positive impact of the intervention on metric measures of cognitive capacity was observed. Medication optimization was only utilized in 6 studies and only two of them showed a significant improvement of cognitive function. The remaining 6 positive studies tested antiparkinsonian medications, methylphenidate, antidepressants, selective estrogen receptor modulators (SERMs), folic acid and antipsychotics. The mean Jadad score was low (2.9). Conclusion This systematic review revealed only a small number of RCT investigating the important clinical problem addressed by this search, and the existing studies are heterogenous. 9/17 trials showed a positive impact on at least one aspect of cognitive capacity, with comprehensive medication optimization not being more successful than focused drug interventions. More prospective trials are needed specifically assessing approaches to limit the negative impact of medications on cognitive capacity in older patients.