TABLE 4B-1, American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults Due to Drug-Disease or Drug-Syndrome Interaction That May Exacerbate the Disease or Syndrome - Cognitive Aging

Disease or Syndrome	Drug	Rationale	Recommendation, Quality of Evidence, and Strength of Recommendation
Delirium	All tricyclic antidepressants Anticholinergics (see Table 4B-2) Benzodiazepines Chlorpromazine Corticosteroids H₂-receptor antagonists Meperidine Sedative hypnotics Thioridazine	Avoid in older adults with or at high risk of delirium because of inducing or worsening delirium in older adults; if discontinuing drugs used chronically, taper to avoid withdrawal symptoms	Recommendation: Avoid Quality of Evidence: Moderate Strength of Recommendation: Strong
Dementia and Cognitive Impairment	Anticholinergics (see Table 4B-2) Benzodiazepines H₂-receptor antagonists Zolpidem Antipsychotics, chronic and as-needed use	Avoid because of adverse central nervous system effects. Avoid antipsychotics for behavioral problems of dementia unless nonpharmacological options have failed, and patient is a threat to themselves or others. Antipsychotics are associated with an increased risk of cerebrovascular accident (stroke) and mortality in persons with dementia	Recommendation: Avoid Quality of Evidence: High Strength of Recommendation: Strong

Disease or Syndrome

Drug

Rationale

Recommendation, Quality of Evidence, and Strength of Recommendation

Delirium

All tricyclic antidepressants
Anticholinergics (see Table 4B-2)
Benzodiazepines
Chlorpromazine
Corticosteroids
H₂-receptor antagonists
Meperidine
Sedative hypnotics
Thioridazine

Avoid in older adults with or at high risk of delirium because of inducing or worsening delirium in older adults; if discontinuing drugs used chronically, taper to avoid withdrawal symptoms

Recommendation: Avoid
Quality of Evidence: Moderate
Strength of Recommendation: Strong

Dementia and Cognitive Impairment

Anticholinergics (see Table 4B-2)
Benzodiazepines
H₂-receptor antagonists
Zolpidem
Antipsychotics, chronic and as-needed use

Avoid because of adverse central nervous system effects. Avoid antipsychotics for behavioral problems of dementia unless nonpharmacological options have failed, and patient is a threat to themselves or others. Antipsychotics are associated with an increased risk of cerebrovascular accident (stroke) and mortality in persons with dementia

Recommendation: Avoid
Quality of Evidence: High
Strength of Recommendation: Strong

From: 4B, Risk and Protective Factors and Interventions: Health and Medical Factors

Cognitive Aging: Progress in Understanding and Opportunities for Action.

Committee on the Public Health Dimensions of Cognitive Aging; Board on Health Sciences Policy; Institute of Medicine; Blazer DG, Yaffe K, Liverman CT, editors.

Washington (DC): National Academies Press (US); 2015 Jul 21.

NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.

TABLE 4B-1American Geriatrics Society Beers Criteria for Potentially Inappropriate Medication Use in Older Adults Due to Drug-Disease or Drug-Syndrome Interaction That May Exacerbate the Disease or Syndrome