Drug-Induced Cognitive Impairment and Dementia

Causes of the development or aggravation of cognitive impairment (CI) may include the use of a number of drugs, including non-steroidal anti-inflammatory drugs, antiarrhythmics, antidepressants, glucocorticosteroids, antitumor drugs, and various others. The adverse effects of drugs on cognitive functions are mediated by many pathophysiological mechanisms: disruption of hormonal regulation, decreased neuronal excitability, increased γ-aminobutyric acid receptor activity, decreased cerebral blood flow, and atrophic changes in the brain; many mechanisms remain to be established definitively. Risk factors for the development of drug-induced (DI) CI are old age, childhood, brain damage, chronic diseases, and genetic factors, along with the presence of early CI in the patient, polypharmacy, dose and duration of drug use, acute infectious diseases, metabolic disorders, dehydration, acute urinary retention, and others. The diagnosis and differential diagnosis of DI CI requires a connection between the start of taking the proposed drug inductor and CI to be established. The first step in the treatment of DI CI is discontinuation of the inducing drug or reduction in the dosage; when discontinuation of the drug is not possible and there is no replacement, special slow-release dosage forms can be considered. The main measures to prevent DI CI include the use of drugs with the lowest risk of their development, assessment of drug interactions, and the use of modern scales to assess the risk of developing this side effect (such as the anticholinergic burden scale).