Department of Psychiatry, School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK.
J Am Geriatr Soc. 2011 Aug;59(8):1477-83. doi: 10.1111/j.1532-5415.2011.03491.x. Epub 2011 Jun 24.
To determine whether the use of medications with possible and definite anticholinergic activity increases the risk of cognitive impairment and mortality in older people and whether risk is cumulative.
A 2-year longitudinal study of participants enrolled in the Medical Research Council Cognitive Function and Ageing Study between 1991 and 1993.
Community-dwelling and institutionalized participants.
Thirteen thousand four participants aged 65 and older.
Baseline use of possible or definite anticholinergics determined according to the Anticholinergic Cognitive Burden Scale and cognition determined using the Mini-Mental State Examination (MMSE). The main outcome measure was decline in the MMSE score at 2 years.
At baseline, 47% of the population used a medication with possible anticholinergic properties, and 4% used a drug with definite anticholinergic properties. After adjusting for age, sex, educational level, social class, number of nonanticholinergic medications, number of comorbid health conditions, and cognitive performance at baseline, use of medication with definite anticholinergic effects was associated with a 0.33-point greater decline in MMSE score (95% confidence interval (CI)=0.03-0.64, P=.03) than not taking anticholinergics, whereas the use of possible anticholinergics at baseline was not associated with further decline (0.02, 95% CI=-0.14-0.11, P=.79). Two-year mortality was greater for those taking definite (OR=1.68; 95% CI=1.30-2.16; P<.001) and possible (OR=1.56; 95% CI=1.36-1.79; P<.001) anticholinergics.
The use of medications with anticholinergic activity increases the cumulative risk of cognitive impairment and mortality.
确定使用具有潜在和明确抗胆碱能活性的药物是否会增加老年人认知障碍和死亡的风险，以及风险是否具有累积性。
1991 年至 1993 年期间参加医学研究委员会认知功能和衰老研究的参与者的为期 2 年的纵向研究。
居住在社区和机构中的参与者。
13400 名年龄在 65 岁及以上的参与者。
根据抗胆碱能认知负担量表确定基线时使用可能或明确抗胆碱能药物的情况，并使用简易精神状态检查（MMSE）确定认知情况。主要结局指标是 2 年后 MMSE 评分的下降。
在基线时，47%的人群使用具有潜在抗胆碱能特性的药物，4%的人群使用具有明确抗胆碱能特性的药物。在调整年龄、性别、教育程度、社会阶层、非抗胆碱能药物数量、合并健康状况数量以及基线时的认知表现后，使用具有明确抗胆碱能作用的药物与 MMSE 评分下降 0.33 分（95%置信区间（CI）=0.03-0.64，P=.03）有关，而不服用抗胆碱能药物与进一步下降无关（0.02，95%CI=-0.14-0.11，P=.79）。服用明确抗胆碱能药物（OR=1.68；95%CI=1.30-2.16；P<.001）和可能抗胆碱能药物（OR=1.56；95%CI=1.36-1.79；P<.001）的患者两年死亡率更高。
使用具有抗胆碱能活性的药物会增加认知障碍和死亡的累积风险。
