Carrière Isabelle, Fourrier-Reglat Annie, Dartigues Jean-François, Rouaud Olivier, Pasquier Florence, Ritchie Karen, Ancelin Marie-Laure
Inserm, U888, Université Montpellier 1, Montpellier, France.
Arch Intern Med. 2009 Jul 27;169(14):1317-24. doi: 10.1001/archinternmed.2009.229.
Despite the high intake of medications with anticholinergic properties by community-dwelling elderly persons, the effects on cognitive decline and dementia have rarely been evaluated.
Participants were 4128 women and 2784 men 65 years or older from a population-based cohort recruited from 3 French cities. Cognitive performance, clinical diagnosis of dementia, and anticholinergic use were evaluated at baseline and 2 and 4 years later.
A total of 7.5% of the participants reported anticholinergic drug use at baseline. Multivariate-adjusted logistic regression indicated that women reporting use of anticholinergic drugs at baseline showed greater decline over 4 years in verbal fluency scores (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.11-1.79) and in global cognitive functioning (OR, 1.22; 95% CI, 0.96-1.55) than women not using anticholinergic drugs. In men, an association was found with decline in visual memory (OR, 1.63; 95% CI, 1.08-2.47) and to a lesser extent in executive function (OR, 1.47; 95% CI, 0.89-2.44). Notable interactions were observed in women between anticholinergic use and age, apolipoprotein E, or hormone therapy. A 1.4- to 2-fold higher risk of cognitive decline was observed for those who continuously used anticholinergic drugs but not for those who had discontinued use. The risk of incident dementia over the 4-year follow-up period was also increased in continuous users (hazard ratio [HR], 1.65; 95% CI, 1.00-2.73) but not in those who discontinued the use of anticholinergic drugs (HR, 1.28; 95% CI, 0.59-2.76).
Elderly people taking anticholinergic drugs were at increased risk for cognitive decline and dementia. Discontinuing anticholinergic treatment was associated with a decreased risk. Physicians should carefully consider prescription of anticholinergic drugs in elderly people, especially in the very elderly and in persons at high genetic risk for cognitive disorder.
尽管社区居住的老年人大量摄入具有抗胆碱能特性的药物，但对认知功能下降和痴呆症的影响却鲜有评估。
参与者为来自法国3个城市的基于人群队列研究中的4128名65岁及以上女性和2784名男性。在基线、2年和4年后评估认知表现、痴呆症的临床诊断以及抗胆碱能药物的使用情况。
共有7.5%的参与者在基线时报告使用抗胆碱能药物。多变量调整后的逻辑回归表明，基线时报告使用抗胆碱能药物的女性在4年内语言流畅性得分下降幅度更大（比值比[OR]，1.41；95%置信区间[CI]，1.11 - 1.79），整体认知功能下降幅度也更大（OR，1.22；95%CI，0.96 - 1.55），高于未使用抗胆碱能药物的女性。在男性中，发现与视觉记忆下降有关（OR，1.63；95%CI，1.08 - 2.47），在执行功能方面下降程度较小（OR，1.47；95%CI，0.89 - 2.44）。在女性中，观察到抗胆碱能药物使用与年龄、载脂蛋白E或激素治疗之间存在显著相互作用。持续使用抗胆碱能药物的人认知功能下降风险高出1.4至2倍，而停药者则未观察到这种情况。在4年随访期内，持续使用者发生痴呆症的风险也增加（风险比[HR]，1.65；95%CI，1.00 - 2.73），但停药者未增加（HR，1.28；95%CI，0.59 - 2.76）。
服用抗胆碱能药物的老年人认知功能下降和痴呆症风险增加。停用抗胆碱能治疗与风险降低相关。医生在为老年人，尤其是高龄老人和认知障碍遗传风险高的人群开具抗胆碱能药物处方时应谨慎考虑。
