De StromenOpmaatGroep, Nursing Home Smeetsland, Rotterdam, the Netherlands.
J Clin Pharmacol. 2012 Jun;52(6):947-55. doi: 10.1177/0091270011405665. Epub 2011 May 31.
The contribution of specific psychotropic drugs to fall risk in patients with dementia has not been quantified precisely until now. The authors evaluated the dose-response relationship between psychotropic drugs and falls in nursing home residents with dementia. Daily drug use and daily falls were recorded in 248 nursing home residents with dementia from January 1, 2006, to January 1, 2008. For each day of the study period, data on drug use were abstracted from the prescription database, and falls were retrieved from a standardized incident report system, resulting in a data set of 85 074 person-days. The authors found significant dose-response relationships for the use of antipsychotics (hazard ratio [HR], 2.78; 95% confidence interval [CI], 1.49-5.17), anxiolytics (1.60; 1.20-2.14), hypnotics and sedatives (2.58; 1.42-4.68), and antidepressants (2.84; 1.93-4.16). Fall risk increased significantly with 28% at 0.25 of the defined daily dose (DDD) of an antipsychotic or antidepressant, with 8% at 0.2 of the DDD of an anxiolytic, and with 56% at 0.5 of the DDD of a hypnotic or sedative; it increased further with dose increments and with combinations of psychotropics. Even at low dosages, psychotropic drugs are associated with increased fall risk in nursing home residents with dementia.
直到现在，特定精神药物对痴呆患者跌倒风险的贡献还没有被精确地量化。作者评估了精神药物与疗养院痴呆患者跌倒之间的剂量-反应关系。2006 年 1 月 1 日至 2008 年 1 月 1 日，作者对 248 名疗养院痴呆患者的每日药物使用和每日跌倒情况进行了评估。在研究期间的每一天，作者从处方数据库中提取药物使用数据，并从标准化事件报告系统中检索跌倒数据，从而得出 85074 人-天的数据集。作者发现抗精神病药物（危险比 [HR]，2.78；95%置信区间 [CI]，1.49-5.17）、抗焦虑药（1.60；1.20-2.14）、催眠镇静剂（2.58；1.42-4.68）和抗抑郁药（2.84；1.93-4.16）的使用与剂量呈显著的剂量-反应关系。跌倒风险随着抗精神病药物或抗抑郁药物的 0.25 个定义日剂量（DDD）增加 28%、抗焦虑药物的 0.20 DDD 增加 8%、催眠镇静剂的 0.50 DDD 增加 56%而显著增加；随着剂量的增加和精神药物的联合使用，跌倒风险进一步增加。即使在低剂量下，精神药物也与疗养院痴呆患者跌倒风险的增加相关。
