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Opioid Prescriptions' Relationship to Cognitive Function in Later Life Examined

A bottle of prescription medication on it's side.
Credit: Kevin Bidwell/ Pexels

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Prescription opioid use could have a negative effect on cognitive function in older adults, according to a recent Mayo Clinic study published in the Journal of the American Geriatrics Society. The population-based observational study used data from the Mayo Clinic Study of Aging, a research initiative examining the cognitive decline in older people for nearly 20 years. 


The study found that 70% of participants received at least one opioid prescription over an average of 7.5 years. Each prescription was linked to declines in cognitive performance, particularly in memory, language and attention. Those receiving opioids also had a 20% higher chance of developing mild cognitive impairment, a state of cognitive decline that exceeds normal aging.

“This information is important to include in shared decision-making between patients and their health care professionals regarding optimal pain management strategies,” says Nafisseh Warner, M.D., an anesthesiologist and pain medicine physician.

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Apart from her clinical duties, Dr. Warner also is heavily engaged in clinical research, which is supported by the National Institute on Aging, and was a Kern Health Care Delivery Scholar at the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery. The Kern Health Care Delivery Scholars Program trains doctoral-level fellows and junior faculty in health services research.

Pain is considered common in older adults, with more than half of those 65 or older experiencing pain on most days. Study authors suggest that when considering the use of prescription opioids in older adults, treatment should be tailored to each patient through assessment of risks and benefits and close clinical follow-up.

The researchers believe that the results of their study could lead to the development of more effective treatment strategies for older adults and help to mitigate the negative impact of prescription opioids on cognitive function.

They note that the mechanisms by which opioids may lead to cognitive decline are not fully understood. The key question is whether observed associations between prescription opioids and cognitive decline show causal relationships, or whether prescription opioids are a marker for other conditions associated with cognitive dysfunction.

“This data, while compelling, does not establish a causal link between prescription opioids and cognitive decline," says Dr. Warner. "However, a clear association exists between opioids and long-term cognitive decline, which should spark conversation when considering whether to start an older adult on a prescription opioid.”

Dr. Warner further states that any treatment decision should be made by considering what matters most to the patient, including the patient's health, life goals and care preferences.   

“When we decide to proceed with opioid therapy, it’s important to optimize other factors that may be protective against cognitive declines, such as sleep, exercise and socialization, “says Dr. Warner.

What's next?

As trends in opioid prescribing for U.S. adults have changed considerably in recent years, future longitudinal studies are necessary to assess the broader view of the study’s findings, evaluate geographic and socioeconomic disparities in prescription opioid availability, and investigate the mechanisms underlying the association between opioid availability and long-term cognitive function in older adults.

The researchers note that this study is a reminder of the need for continued research on the effect of prescription opioids on older adults and the importance of considering the potential consequences of opioid use in this population. They plan to continue their work to understand the long-term effect of prescription opioids on cognitive function in older adults and to develop practical solutions to address this issue.

Reference: Warner NS, Hanson AC, Schulte PJ, Habermann EB, Warner DO, Mielke MM. Prescription opioids and longitudinal changes in cognitive function in older adults: A population-based observational study. J Am Geriatr Soc. 2022;70(12):3526-3537. doi: 10.1111/jgs.18030

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