Aim: To describe the prevalence of opioid use in persons with a cognitive impairment compared
with cognitively intact persons and to explore factors associated with opioid prescription.
Method: A search was made in PubMed (Medline), Embase, Cochrane, Central, Cinahl, PsychInfo and
Web of Science and additional articles were identified by manual search of reference lists. Titles and abstracts
were screened and eligible articles reviewed in full-text. A citation check was performed on the included
articles for a complete search. Risk of bias of the included studies was assessed using an appropriate
Results: The search yielded 610 unique hits and an additional 33 records were identified via reference
checking. After screening, 23 studies were included. A citation tracking was performed for these 23 articles
using Web of Science, which yielded an additional 421 articles for a second screening. After the second
screening, 24 studies were included. Opioid use was divided into three classes: weak, strong, and weak and
strong combined. In several articles there were more than one study conclusion on different opioid classes
or in a different setting. Analysis was performed on the prevalence of opioid use (prescription rates) and the
dosage of opioids. The 24 studies yielded a total of 35 study conclusions related to prescription rates and
dosage. Of these, four showed a higher use of opioids in persons with a cognitive impairment, 14 an equal
distribution, and 17 showed lower opioid use in cognitively impaired persons.
Conclusion: This systematic review provides evidence for general undertreatment of pain with opioids in
persons with a cognitive impairment.