Subclinical hyperthyroidism modestly increases the risk of cognitive impairment and dementia. Hypertension is also a risk factor for cognitive impairment and dementia. There is a risk of severe renal impairment. Patients with a history of orthostatic hypotension or severe hepatic impairment. No dose adjustment is needed for patients with renal impairment and moderate hepatic impairment. Most patients show some degree of cognitive impairment. There are reports of reversible cognitive impairment with statins. Digoxin toxicity increases in individuals who have kidney impairment. No dose adjustment is needed for patients with renal impairment. Paralysis increases, and convulsions, mental impairment, and cardiac arrhythmia may occur. The earliest stage of dementia is called mild cognitive impairment (MCI). Dose adjustment is required in the elderly and in those with renal impairment. Alfuzosin should not be used for patients with renal impairment. However, it can appear to occur in conjunction with virtually any neurological impairment. Agomelatine is contraindicated in patients with kidney or liver impairment.