Cognitive Functioning in Older Adults With Personality Disorders Related to Psychotropic Medication Use and Mood State

Background Older adults with personality disorders (PDs) may experience reduced cognitive functioning, which could interfere with appropriate care and treatment. Cognitive functioning may be affected by psychotropic medication use and negative mood state, both common in this group. Objectives This study examined cognitive functioning in older adults with PDs compared to healthy comparisons, taking into account psychotropic use and mood state. Methods The PhArmacotherapy aND pOlypharmacy in oldeR Adults (PANDORA) study (2018–2023, the Netherlands) was a cross-sectional study including 134 participants aged 60+ (58 with PDs, 76 healthy comparisons). Cognitive functioning was assessed using tests for verbal memory (12-word Learning Test), spatial memory (Visuospatial Learning Test), and executive functioning (Concept Shifting Test and Tower of London). Psychotropics with Adverse Cognitive Effects (PACE) included tricyclic antidepressants (TCAs), antipsychotics, benzodiazepines and promethazine. Mood state was assessed with the Profile of Mood States-Short Form (POMS-sf). Results Older adults with PDs performed worse on immediate and delayed recall, ToL, CST only after outlier removal, but not on VSLT. In the PD group, PACE use predicted poorer delayed recall and ToL performance. When excluding PACE users, group differences between PD group and healthy comparisons largely disappeared, except for ToL performance. Additionally, negative mood state predicted poorer verbal memory and CST performance. Conclusions In our study, older adults with PDs showed poorer cognitive functioning, associated with both psychotropic use and mood state. This may necessitate adaptations in psychotherapy and in pharmacotherapy. Longitudinal studies should explore causality and interventions to preserve cognitive functioning in this population.