P2‐572: Inappropriate Medication Use Associated With Lower Cognitive Reserve in Individuals With Pre‐clinical Alzheimer's Disease
Year: 2019
Type: article
Abstract: Augmenting cognitive reserve (CR) is an important strategy to delay progression from preclinical Alzheimer's disease (pAD) to symptomatic AD. Because studies have shown that potentially inappropriate medication (PIM) use may lower cognitive reserve, optimizing medication may protect against AD. In this abstract, we investigate the association between baseline medication appropriateness and measures of CR among participants enrolled in a randomized medication therapy management trial. Total brain relative standardized uptake values (SUVR) > 1.4 for PET amyloid was used as the pAD threshold. Tests of executive function (Trail Making Test B; TMBT) and immediate recall (California Verbal Learning Test Trials 1-5; CVLT) were administered under anticholinergic challenge, and again four weeks later unchallenged. Standardized change scores were calculated and used as a surrogate for CR, with larger change scores between the two paradigms corresponding to lower CR (i.e. the participant is less able to compensate for anticholinergic challenge). The Medication Appropriateness Index was calculated for medications in the 2015 Beers’ Criteria (MAI-PIM). Spearman correlation coefficients (r) were used to assess the relationship between baseline medication appropriateness and CR. P-values of <0.05 were considered statistically significant. Based on 41 included participants (mean age 73.1 years [SD 5.7]; 66% female), the median (IQR) MAI-PIM at baseline was 4 (0.5-6.5), and 34.3% met criteria for pAD. Those with pAD had larger change scores for both executive function and immediate recall (mean [SD] TMTB −0.34 [1.2]; 0.08 [1.1] and CVLT 9.0 [6.8]; 3.3 [7.4] for pAD and non-pAD respectively). Higher MAI-PIM scores were correlated with larger change scores (r=0.27 [p=0.087] and r=0.33 [p=0.036] for TMTB and CVLT respectively). Among community-dwelling non-demented older adults, anticholinergic challenge resulted in larger observed differences in cognitive test scores both among participants with evidence of pAD and among participants taking more PIMs. These results support the hypothesized relationship between CR and medication appropriateness. 1) Moga DC et al. Alzheimers Res Ther. 2017;9(1):36. 2) Moga DC, Jicha GJ. https://clinicaltrials.gov/ct2/show/NCT02849639. 3) Jack CR et al. Brain. 2015;138(12):3747-3759. 4) Hanlon JT et al. J Clin Epidemiol. 1992;45(10):1045-1051. 5) American Geriatrics Society. J Am Geriatr Soc. 2015;63(11):2227-2246.
Source: Alzheimer s & Dementia
Institution: University of Kentucky
Language: English
Subfield: Geriatrics and Gerontology
Field: Medicine
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2980998545