Cogstate CIO, Paul Maruff, recently hosted the webinar, Using Cognition to Understand Effects of Medicines Used to Optimize Sleep or Wakefulness. Following the event, he elaborated on some critical questions about the sedative effect on cognition in different age groups and populations, and discussed if similarities in fatigue were experienced by different patient populations. Here we share key insights from that discussion:
Sedative Effects on Cognition in Different Age Groups
Q: Do you think the sedative effects of drugs on cognition, such as benzodiazepines, observed in healthy adults provide a good basis for estimating their effects in older healthy adults?
A: No, we know that drugs like benzodiazepines or other sedative drugs tend to have greater effects on cognition in older adults compared to younger adults. The detrimental effects on cognition in older adults are typically more pronounced. This difference can be due to several factors, but it highlights the importance of evaluating these drugs’ effects in older populations, often at lower doses.
Sedative Effects on Cognition in Different Patient Populations
Q: Do you think the sedative effects on cognition of drugs such as benzodiazepines observed in healthy young adults provide a good basis for estimating their effects in different patient populations?
A: The same issues that apply to older adults also apply to other patient populations. Firstly, patient populations may have the disorder of interest and other comorbid disorders. For instance, the cognitive effects of a drug like benzodiazepine might be less pronounced in patients with disorders like schizophrenia or major depressive disorder than in healthy young adults. Additionally, patient populations often take other medications, which can interact with the sedative drug, affecting its cognitive impact. Therefore, while these observations provide a starting point, it is crucial to demonstrate the safety and effects in the specific population of interest.
Comparing Fatigue in MS and Parkinson’s Disease
Q: Do you think the fatigue reported by people with MS is similar in etiology to that reported by people with Parkinson’s disease? If so, would you see the same wake-promoting drugs as being equally effective in these two patient populations?
A: Fatigue is a common symptom in many neurological and psychiatric disorders, as well as systemic disorders. While the presenting characteristics of fatigue—such as low energy, low motivation, and difficulty staying awake—are similar across different conditions, the underlying biology may not be the same. There is no strong evidence to suggest that the biology of fatigue in Parkinson’s disease is identical to that in multiple sclerosis. Consequently, a drug designed to counter fatigue might need different mechanisms of action and dosing regimens for different disorders. It’s essential to be cautious about considering fatigue as a single manifestation of a common underlying pathology.
Learn More
For a deeper dive, check out the following resources:
Fact Sheet: Enhancing Sedation and Wakefulness Decision-Making in Sleep Clinical Trials
Webinar: Using Cognition to Understand Effects of Medicines Used to Optimize Sleep or Wakefulness
