Even after years of warnings, millions of older Americans with dementia are still being prescribed risky brain-altering drugs—often with no clear medical justification.
Even after years of clinical guidance cautioning against their use, about one in four Medicare beneficiaries living with dementia are still prescribed brain-altering medications tied to serious side effects such as falls, confusion, and hospitalization. The findings come from new research scheduled for publication today (January 12) in the peer-reviewed journal JAMA.
Overall prescribing of these medications has declined over time. Among all Medicare beneficiaries, use dropped from 20% to 16% during the nine-year study period. However, people with cognitive impairment continue to receive these drugs at higher rates, despite being especially vulnerable to their harmful effects.
“While this decline was encouraging, over two-thirds of patients receiving these prescriptions lacked a documented clinical indication in 2021, the end of the study period, suggesting high levels of potentially inappropriate and harmful prescribing,” said senior author Dr. John N. Mafi, associate professor-in-residence of medicine, division of general internal medicine and health services research, at the David Geffen School of Medicine at UCLA.
“Compared with patients with normal cognition, we also found higher levels of prescribing among older adults with cognitive impairment, who face a higher risk of adverse effects from these drugs. These results underscore substantial opportunities to improve the quality and safety of care for millions of older Americans.”
How the Researchers Tracked Prescribing Patterns
To conduct the analysis, researchers combined survey data from the Health and Retirement Study with Medicare fee-for-services claims. They examined prescribing patterns for possibly inappropriate central nervous system (CNS)-active medications between January 1, 2013 through December 31, 2021. The study focused on older adults in three groups: those with 1) normal cognition, 2) cognitive impairment without dementia, and 3) dementia.
The medications reviewed fell into five categories: antidepressants with strong anticholinergic properties, antipsychotics, barbiturates, benzodiazepines, and non-benzodiazepine hypnotics.
Higher Use Among Those With Cognitive Impairment
The analysis found clear differences across cognitive groups. CNS-active medications were prescribed to 17% of older adults with normal cognition. Nearly 22% of individuals with cognitive impairment but no dementia received these drugs. Among those with dementia, the figure rose to about 25%.
When looking at specific medication types among all Medicare fee-for-service beneficiaries, trends varied by drug class. Use of benzodiazepines declined from 11.4% to 9.1%. Prescriptions for nonbenzodiazepine hypnotics, often used as sleep medications, fell from 7.4% to 2.9%. In contrast, antipsychotic use increased from 2.6% to 3.6%. Prescribing of anticholinergic antidepressants remained steady at 2.6% throughout the study period, while barbiturate use declined slightly from 0.4% to 0.3%.
Signs of Progress Alongside Ongoing Concerns
Clinically justified prescriptions decreased modestly, falling from 6% in 2013 to 5.5% in 2021. At the same time, prescriptions considered likely inappropriate dropped more substantially, from 15.7% to 11.4%. Much of this improvement was driven by reduced use of benzodiazepines and sleep medications, along with fewer inappropriate prescriptions overall.
The researchers note several limitations. The study did not include Medicare Advantage data, some clinical details such as agitation may have been missing, and the analysis focused on how common these prescriptions were rather than how long patients were exposed to them.
“While CNS-active prescriptions may be appropriate in some cases, it is important for older patients or their caregivers to work closely with their physicians to ensure that these medications are appropriate to their cases. When inappropriate, patients and their care teams should consider alternative treatments and consider whether it might be safe to taper or stop the medication,” said Dr. Annie Yang, a scholar in the National Clinician Scholars Program at Yale University who led this study as a UCLA internal medicine resident.
Reference: “Prescribing Patterns of Potentially Inappropriate CNS-Active Medications in Older Adults” by Annie W. Yang, Mei Leng, Dan P. Ly, Chi-Hong Tseng, Catherine Sarkisian, Cheryl L. Damberg, Nina T. Harawa, A. Mark Fendrick and John N. Mafi, 12 January 2026, JAMA.
DOI: 10.1001/jama.2025.23697
The study was co-authored by Mei Leng, Dr. Dan Ly, Chi-Hong Tseng, Dr. Catherine Sarkisian, and Nina Harawa of UCLA, along with Cheryl Damberg of RAND and Dr. A. Mark Fendrick of University of Michigan. Ly and Sarkisian are also affiliated with VA Greater Los Angeles Healthcare System.
Funding was provided by the National Institutes of Health and the National Institute on Aging (R01AG070017-01).
Never miss a breakthrough: Join the SciTechDaily newsletter.
Follow us on Google and Google News.