COGNITIVE-RISK MEDICATION USE AND ITS POTENTIAL ASSOCIATION WITH COGNITIVE VULNERABILITY AMONG OLDER ADULTS RECEIVING OUTPATIENT CARE IN THE BRAZILIAN PUBLIC HEALTH SYSTEM

INTRODUCTION: Population aging evokes an increasing prevalence of chronic diseases, and polypharmacy as well as the use of potentially inappropriate medications (PIMs). Among the associated risks, adverse effects on cognitive function represent an important clinical concern in older adults, highlighting the potential role of screening tools such as the STOPP-Cog criteria in identifying medications associated with cognitive risk and supporting deprescribing decisions. AIMS: This study aimed to estimate the prevalence of exposure to potentially inappropriate medications associated with cognitive risk, investigate their sociodemographic, clinical, and pharmacotherapeutic determinants, and examine their associations with cognitive vulnerability and medication adherence among older adults attending outpatient clinics within the Brazilian Public Health System. MATERIALS AND METHODS: This cross-sectional study included 595 older adults attending specialized SUS outpatient clinics in Curitiba and Londrina, Brazil. Data was obtained through structured interviews and electronic medical record review. Cognitive performance was assessed using the Montreal Cognitive Assessment (MoCA), global anticholinergic and sedative medication burden using the Drug Burden Index (DBI), exposure to cognitive-risk medications using the STOPP-Cog criteria, and medication adherence using the Medication Adherence Rating Scale (MAT). Statistical analyses were performed using Stata, with Pois sonha regression with robust variance to identify factors associated with use of cognitive risk medications. RESULTS: This study included 597 participants. The median age was 70.2 years (IQR: 65.4–76.2), 56.3% of participants were female, and the median number of medications used was 6 (IQR: 4–8). Exposure to medications identified by the STOPP-Cog criteria was observed in 27.8% of the sample. Poorer cognitive performance was significantly associated with lower medication adherence (β = −0.023; p < 0.001) and STOPP-Cog exposure (β = 1.059; p < 0.001). A significant interaction between cognitive performance and STOPP-Cog exposure was identified (β = 0.036; p = 0.031), suggesting that the relationship between cognitive performance and medication adherence differed according to exposure to cognitive-risk medications. No significant interaction was observed between STOPP-Cog exposure and therapeutic regimen complexity (p = 0.445). FINAL CONSIDERATIONS: Exposure to potentially inappropriate medications associated with cognitive risk was common among older adults receiving outpatient care at the public health system. Decline in cognitive performance and exposure to STOPP-Cog medications were associated with reduced medication adherence, and their significant interaction suggests that cognitive-risk pharmacotherapy may modify the relationship between cognition and adherence. These findings reinforce the importance of incorporating cognitive-risk medication assessment into pharmacotherapy reviews and medication optimization strategies for older adults.

KEYWORDS: Older Adults; Polypharmacy; Cognition; Potentially Inappropriate Medications; Medication Adherence; Cognitive Risk.