Malinee Neelamegam1,2, Janice Zgibor2, Henian Chen2, Kathleen O'rourke2, Chighaf Bakour2, Lakshminarayan Rajaram2, Kaarin J Anstey3,4,5. 1. Yale School of Public Health, Yale University, New Haven, CT, USA. 2. College of Public Health, University of South Florida, Tampa, FL, USA. 3. Centre for Research on Ageing, Health and Wellbeing, Australian National University, Canberra, Australia. 4. School of Psychology, University of New South Wales, Sydney, Australia. 5. Neuroscience Research Australia, Sydney, Australia.
Abstract
BACKGROUND: chronic pain, a common complaint among older adults, affects physical and mental well-being. While opioid use for pain management has increased over the years, pain management in older adults remains challenging, due to potential severe adverse effects of opioids in this population. OBJECTIVE: we examined the association between opioid use, and changes in cognitive function of older adults. DESIGN: prospective study. SETTING: community dwelling older adults. SUBJECTS: study population consisted of 2,222 individuals aged 65-69 years at baseline from the Personality and Total Health Through Life Study in Australia. METHODS: medication data were obtained from the Pharmaceutical Benefits Scheme. Cognitive measures were obtained from neuropsychological battery assessment. Opioid exposure was quantified as Total Morphine Equivalent Dose (MED). The association between change in cognitive function between Wave 2 and Wave 3, and cumulative opioid use was assessed through generalized linear models. RESULTS: cumulative opioid exposure exceeding total MED of 2,940 was significantly associated with poorer performance in the Mini Mental State Examination (MMSE). Compared with those not on opioids, individuals exposed to opioids resulting in cumulative total MED of greater than 2,940 had significantly lower scores in the MMSE (Model 1: β = -0.34, Model 2: β = -0.35 and Model 3: β = -0.39, P < 0.01). Performance in other cognitive assessments was not associated with opioid use. CONCLUSION: prolonged opioid use in older adults can affect cognitive function, further encouraging the need for alternative pain management strategies in this population. Pain management options should not adversely affect healthy ageing trajectories and cognitive health.
BACKGROUND: chronic pain, a common complaint among older adults, affects physical and mental well-being. While opioid use for pain management has increased over the years, pain management in older adults remains challenging, due to potential severe adverse effects of opioids in this population. OBJECTIVE: we examined the association between opioid use, and changes in cognitive function of older adults. DESIGN: prospective study. SETTING: community dwelling older adults. SUBJECTS: study population consisted of 2,222 individuals aged 65-69 years at baseline from the Personality and Total Health Through Life Study in Australia. METHODS: medication data were obtained from the Pharmaceutical Benefits Scheme. Cognitive measures were obtained from neuropsychological battery assessment. Opioid exposure was quantified as Total Morphine Equivalent Dose (MED). The association between change in cognitive function between Wave 2 and Wave 3, and cumulative opioid use was assessed through generalized linear models. RESULTS: cumulative opioid exposure exceeding total MED of 2,940 was significantly associated with poorer performance in the Mini Mental State Examination (MMSE). Compared with those not on opioids, individuals exposed to opioids resulting in cumulative total MED of greater than 2,940 had significantly lower scores in the MMSE (Model 1: β = -0.34, Model 2: β = -0.35 and Model 3: β = -0.39, P < 0.01). Performance in other cognitive assessments was not associated with opioid use. CONCLUSION: prolonged opioid use in older adults can affect cognitive function, further encouraging the need for alternative pain management strategies in this population. Pain management options should not adversely affect healthy ageing trajectories and cognitive health.
Authors: S N Raja; J A Haythornthwaite; M Pappagallo; M R Clark; T G Travison; S Sabeen; R M Royall; M B Max Journal: Neurology Date: 2002-10-08 Impact factor: 9.910
Authors: Kristine E Ensrud; Terri Blackwell; Carol M Mangione; Paula J Bowman; Douglas C Bauer; Ann Schwartz; Joseph T Hanlon; Michael C Nevitt; Mary A Whooley Journal: Arch Intern Med Date: 2003-04-28
Authors: Margaret A Pisani; Terrence E Murphy; Katy L B Araujo; Patricia Slattum; Peter H Van Ness; Sharon K Inouye Journal: Crit Care Med Date: 2009-01 Impact factor: 7.598
Authors: Juha Puustinen; Janne Nurminen; Minna Löppönen; Tero Vahlberg; Raimo Isoaho; Ismo Räihä; Sirkka-Liisa Kivelä Journal: BMC Geriatr Date: 2011-11-01 Impact factor: 3.921
Authors: Fabio Guerriero; Anna Roberto; Maria Teresa Greco; Carmelo Sgarlata; Marco Rollone; Oscar Corli Journal: Drug Des Devel Ther Date: 2016-04-19 Impact factor: 4.162