{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T18:53:09Z","timestamp":1790967189892,"version":"4.1.0"},"reference-count":11,"publisher":"Walter de Gruyter GmbH","license":[{"start":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T00:00:00Z","timestamp":1790899200000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/3.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Cognitive impairment is prevalent among older heart failure (HF) outpatients. Polypharmacy and potentially inappropriate medications (PIMs) may contribute to cognitive vulnerability, yet evidence using the Beers Criteria 2023 with locally validated cognitive screening in Indonesia remains limited.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A cross-sectional analytic study enrolled 107 consecutive HF outpatients aged 60 years or older at a tertiary teaching hospital in Medan, North Sumatra, Indonesia (August to October 2025). Polypharmacy was categorized as non-polypharmacy, polypharmacy, or hyperpolypharmacy. PIM exposure was classified by Beers Criteria 2023. Cognitive function was assessed by MoCA-INA v7.1. Proportional-odds ordinal logistic regression was used with collinearity assessed by variance inflation factors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Mean age was 67.6\u00b16.2 years; 59 (55%) were female. Polypharmacy (72%) and hyperpolypharmacy (23%) were prevalent; severe PIM exposure occurred in 39%. Mean MoCA-INA was 22.0\u00b13.3; 78% had mild cognitive impairment and 10% had mild to moderate dementia. Cognitive category correlated with polypharmacy (\u03c1=0.276; p=0.004) and PIM level (\u03c1=0.264; p=0.006). All VIFs were below 1.5. In the fully adjusted model, education was independently protective (aOR 0.82 per year; 95% CI 0.68 to 0.99; p=0.04) and HFrEF was associated with worse cognition (aOR 6.10; 95% CI 1.25 to 29.87; p=0.03). Polypharmacy (aOR 2.88; p=0.10) and PIM burden (aOR 1.70; p=0.10) showed directionally consistent but inconclusive adjusted associations (Nagelkerke R\n                      <jats:sup>2<\/jats:sup>\n                      =0.368).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Higher medication burden and Beers-2023 PIM exposure were associated with worse cognitive status in unadjusted analyses; adjusted models showed directionally consistent but statistically inconclusive associations (polypharmacy aOR=2.88, p=0.099; PIM burden aOR=1.70, p=0.098). HFrEF was the most robust independent predictor of worse cognitive status (aOR 6.10; 95% CI 1.25 to 29.87; p=0.03), consistent across all three adjusted models. Education was independently protective. Routine cognitive screening integrated with structured medication review is warranted in HF outpatient care, with particular attention to patients with HFrEF phenotype.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.2478\/rjim-2026-0021","type":"journal-article","created":{"date-parts":[[2026,10,2]],"date-time":"2026-10-02T17:57:11Z","timestamp":1790963831000},"source":"Crossref","is-referenced-by-count":0,"title":["Polypharmacy and Potentially Inappropriate Medications: Cognitive Consequences in Older Heart Failure Outpatients"],"prefix":"10.2478","author":[{"given":"Dina Aprillia","family":"Ariestine","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Faculty of Medicine , Universitas Sumatera Utara , Medan , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salomo Malkysua","family":"Sinamo","sequence":"additional","affiliation":[{"name":"Undergraduate Program of Medicine, Faculty of Medicine , Universitas Sumatera Utara , Medan , Indonesia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"374","published-online":{"date-parts":[[2026,10,2]]},"reference":[{"key":"2026100217570683586_j_rjim-2026-0021_ref_001","doi-asserted-by":"crossref","unstructured":"YANG M., SUN D., WANG Y., YAN M., ZHENG J., REN J. Cognitive impairment in heart failure: landscape, challenges, and future directions. Front Cardiovasc Med. 2021;8:831734.","DOI":"10.3389\/fcvm.2021.831734"},{"key":"2026100217570683586_j_rjim-2026-0021_ref_002","doi-asserted-by":"crossref","unstructured":"ALJEAIDI MS., TAN EC. The association between polypharmacy and cognitive ability in older adults: a national cohort study. Res Social Adm Pharm. 2022;18(3):2505\u20139.","DOI":"10.1016\/j.sapharm.2021.04.018"},{"key":"2026100217570683586_j_rjim-2026-0021_ref_003","doi-asserted-by":"crossref","unstructured":"YU X., QIAN Y., ZHANG Y., CHEN Y., WANG M. Association between polypharmacy and cognitive impairment in older adults: a systematic review and meta-analysis. Geriatr Nurs. 2024;59:330\u20137.","DOI":"10.1016\/j.gerinurse.2024.07.005"},{"key":"2026100217570683586_j_rjim-2026-0021_ref_004","doi-asserted-by":"crossref","unstructured":"AMERICAN GERIATRICS SOCIETY. American Geriatrics Society 2023 updated AGS Beers Criteria for potentially inappropriate medication use in older adults. J Am Geriatr Soc. 2023;71(7):2052\u201381.","DOI":"10.1111\/jgs.18372"},{"key":"2026100217570683586_j_rjim-2026-0021_ref_005","doi-asserted-by":"crossref","unstructured":"WOUTERS H., HILMER SN., GNJIDIC D., VAN CAMPEN JP., TEICHERT M., VAN DER MEER HG., et al. Long-term exposure to anticholinergic and sedative medications and cognitive and physical function in later life. J Gerontol A Biol Sci Med Sci. 2020;75(2):357\u201365.","DOI":"10.1093\/gerona\/glz019"},{"key":"2026100217570683586_j_rjim-2026-0021_ref_006","unstructured":"HUSEIN N., LUMEMPOUW S., RAMLI Y. Validity and reliability testing of the Indonesian version of the Montreal Cognitive Assessment (MoCA-INA) for screening cognitive impairment. [article in Indonesian]. Neurona. 2010;27(4):1\u201310."},{"key":"2026100217570683586_j_rjim-2026-0021_ref_007","doi-asserted-by":"crossref","unstructured":"RAMBE AS., FITRI FI. Correlation between the Montreal Cognitive Assessment-Indonesian Version (MoCA-INA) and the Mini-Mental State Examination (MMSE) in elderly. Open Access Maced J Med Sci. 2017;5(7):915\u20139.","DOI":"10.3889\/oamjms.2017.202"},{"key":"2026100217570683586_j_rjim-2026-0021_ref_008","doi-asserted-by":"crossref","unstructured":"ABDULAH R., INSANI WN., DESTIANI DP., ROHMANIASARI N., MOHENATHAS ND., BARLIANA MI. Polypharmacy leads to increased prevalence of potentially inappropriate medication in the Indonesian geriatric population visiting primary care facilities. Ther Clin Risk Manag. 2018;14:1591\u20137.","DOI":"10.2147\/TCRM.S170475"},{"key":"2026100217570683586_j_rjim-2026-0021_ref_009","unstructured":"HAIR JF., BLACK WC., BABIN BJ., ANDERSON RE. Multivariate Data Analysis. 8th ed. Cengage Learning; 2019."},{"key":"2026100217570683586_j_rjim-2026-0021_ref_010","doi-asserted-by":"crossref","unstructured":"UCHMANOWICZ I., GOBBENS RJ. The relationship between frailty, anxiety and depression, and health-related quality of life in elderly patients with heart failure. Clin Interv Aging. 2015;10:1595\u2013600.","DOI":"10.2147\/CIA.S90077"},{"key":"2026100217570683586_j_rjim-2026-0021_ref_011","doi-asserted-by":"crossref","unstructured":"COUPLAND CAC., HILL T., DENING T., MORRISS R., MOORE M., HIPPISLEY-COX J. Anticholinergic drug exposure and the risk of dementia: a nested case-control study. 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