Overutilization of Potentially Inappropriate Medications Can Cause Cognitive Harm in Older Women With Breast Cancer

Jessica Bard

Health care providers should be vigilant about the overutilization of potentially inappropriate medications (PIMs) and anticholinergic cognitive burden (ACB) medications that cause cognitive harm in their patients who are aged 60 years or older with breast cancer, according to the results of a recent study presented at the 2023 Hematology/Oncology Pharmacy Association annual conference.

“PIM use, anticholinergic burden, and cognitive impairment were common in older women with breast cancer in this study,” the researchers concluded.

The researchers aimed to understand the prevalence of PIMs and ACB medications in older women with breast cancer using revised criteria and identify associations between PIM use and ACB, clinical factors, and demographic variables.

The researchers conducted a prospective, 24-month study, which enrolled 40 women with breast cancer who were aged 60 years or older from the ambulatory clinic at Sidney Kimmel Cancer Center in Philadelphia, PA from 2019 to 2021.

The researchers defined PIMs using the 2019 Beers criteria, the ACB Scale was used to define ACB, the short Montreal Cognitive Assessment (s-MOCA) was used as a screening test, the Trail Making Test Part B was used to assess executive functioning and processing speed, and the Subjective Memory Assessment was used to record subjective reports.

Of the 40 women participants, 26 were White, 28 were non-Hispanic, 19 were married, 33 had a college-level education, 30 had early-stage disease, and 27 had an Eastern Cooperative Oncology Group performance status greater than or equal to 1. Additionally, 23 reported subjective memory problems, and 18 participants scored less than 13 points on the s-MOCA scale.

The mean number of medications was 10.8, and the PIM use and anticholinergic burden were common, with 24 participants taking one or more PIM, and 23 taking an ACB medication with a score of greater than or equal to 1.

The baseline variables linked with cognitive impairment were a higher number of medications, PIM use, and ACB score.

Future studies are needed to analyze PIM- and ACB-deprescribing interventions to optimize the use of medications linked to cognitive health, according to the researchers.


Nightingale G. Potentially inappropriate medication (PIM) use and cognition in older women with breast cancer. Poster presented at: Hematology/Oncology Pharmacy Association annual conference; March 29-April 1, 2023; Phoenix, AZ. Accessed April 4, 2023.