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Drug-induced cognitive impairment

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Many classes of medications, such as antipsychotics, anticonvulsants, anticholinergics, and other commonly prescribed drugs, can cause cognitive impairment (CI). The negative effect of drugs on cognitive functions is due to the following pathophysiological mechanisms: a reduction in neuronal excitability, an increase in gamma-aminobutyric acid activity, and decreases in enzyme activity, the number of receptors, cerebral perfusion, as well as brain atrophy; moreover, a number of mechanisms have not been fully studied. An important role in the development of drug-induced CI is played by predisposing (senility or childhood, brain damage, chronic diseases, functional disorders, genetic causes, initial cognitive decline, polypragmasia), and precipitating (acute diseases, infections, metabolic disorders, dehydration, acute urinary retention, malnutrition, environmental influences, etc.) factors. The dose of a drug, the duration of its use is of absolute value. There is a need for the differential diagnosis of CI induced by drugs and CI directly related to the diseases, for which these drugs are prescribed. Drug-induced CI should be suspected if an association is established between a decline of cognitive functions and the start of drug intake. The treatment of this CI involves primarily dose withdrawal or reduction and the use of sustained-release dosage forms, if available. In some cases, cognitive training and/or special drug therapy may be required to correct the CI that has occurred. The measures to prevent drug-induced KI include the choice of the lowest-risk drugs, the use of current side-effect rating scales, in particular an anticholinergic burden scale.

About the Authors

O. D. Ostroumova
Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia; I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

Olga Dmitrievna Ostroumova.

2/1, Barrikadnaya St., Build. 1, Moscow 125993; 8, Trubetskaya St., Build. 2, Moscow 119991.

M. I. Kulikova
Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Russian Federation

2/1, Barrikadnaya St., Build. 1, Moscow 125993.

T. M. Ostroumova
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

8, Trubetskaya St., Build. 2, Moscow 119991.

M. S. Chernyaeva
War Veterans Hospital Two, Moscow Healthcare Department
Russian Federation

168, Volgogradsky Prospect, Build. 1, Moscow 109472.

A. I. Kochetkov
Russian Medical Academy of Continuing Professional Education, Ministry of Health of Russia
Russian Federation

2/1, Barrikadnaya St., Build. 1, Moscow 125993.

V. A. Parfenov
I.M. Sechenov First Moscow State Medical University (Sechenov University), Ministry of Health of Russia
Russian Federation

8, Trubetskaya St., Build. 2, Moscow 119991.


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For citation:

Ostroumova O.D., Kulikova M.I., Ostroumova T.M., Chernyaeva M.S., Kochetkov A.I., Parfenov V.A. Drug-induced cognitive impairment. Neurology, Neuropsychiatry, Psychosomatics. 2020;12(3):11-18. (In Russ.)

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