Bisoprolol-Associated Cognitive Impairment Mimicking Dementia in an Older Adult: An Evidence-Based Family Medicine Case Report

Abstract

Introduction: Cognitive impairment in older adults may resemble dementia, particularly among patients with hypertension, frailty, and polypharmacy. High-dose bisoprolol may contribute to potentially reversible cognitive symptoms. Objective: This case highlights the importance of biopsychosocial assessment in identifying suspected medication-associated cognitive impairment. Case Report: An older hypertensive patient with frailty and sarcopenia presented with memory loss, language difficulties, executive dysfunction, and neuropsychiatric symptoms suggestive of dementia. Comprehensive family physician assessment included medication review, cognitive examination, and family interviews. Discussion: Symptom onset was temporally associated with high-dose bisoprolol use. Cognitive and neuropsychiatric symptoms improved following dose adjustment under clinical monitoring, suggesting a possible medication-related contribution without establishing causality. Conclusion: A biopsychosocial approach incorporating medication reconciliation, cognitive monitoring, and caregiver involvement supports accurate differential diagnosis and individualized management. This case emphasizes the importance of recognizing potentially reversible cognitive impairment while maintaining appropriate cardiovascular treatment in vulnerable older adults