Wehling M
Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Klinische Pharmakologie Mannheim, Medizinische Fakultät Mannheim, Ruprecht-Karls-Universität Heidelberg, Maybachstr. 14, 68169, Mannheim, Deutschland.
Internist (Berl). 2012 Oct;53(10):1240-7. doi: 10.1007/s00108-012-3125-3.
Cognitive impairment is a growing problem in aging societies, and dementia is turning into an epidemic. Modifiable conditions are of major interest, as a causal treatment of dementia is still unknown. Drugs represent a major reversible contributor to cognitive deficits and delirium which is seen in 12-50% of elderly in-hospital patients. A third of patients with delirium is being attributed to drugs, and age-related multimorbidity and subsequent polypharmacy are dominant risk factors. The anticholinergic mechanism is not sufficient to explain delirant drug side effects. Most prevalent in the induction of delirium are psychotropic drugs, in particular benzodiazepines, opiates, tricyclic antidepressants, and typical neuroleptics. In addition, "peripheral" drugs such as oxybutynin or fluorquinolones are involved. Rationalization of drug therapy is the clue for the prevention of cognitive impairment and delirium; most causative drugs are contained in negative lists (e.g., Beers list) and should be replaced by positively labelled drugs (e.g., by virtue of the FORTA classification). On top of the treatment of other modifiable causes for delirium (such as dehydration, infections, and fever), the avoidance or at least optimization of psychotropic drug prescriptions are key elements of the prevention of cognitive impairment in the elderly.
认知障碍在老龄化社会中是一个日益严重的问题，而痴呆症正演变成一种流行病。可改变的状况备受关注，因为痴呆症的病因治疗仍然未知。药物是导致认知缺陷和谵妄的主要可逆因素，在12%至50%的老年住院患者中可见。三分之一的谵妄患者归因于药物，与年龄相关的多种疾病及随后的多药联用是主要危险因素。抗胆碱能机制不足以解释导致谵妄的药物副作用。引发谵妄最常见的是精神药物，尤其是苯二氮䓬类药物、阿片类药物、三环类抗抑郁药和典型抗精神病药物。此外，“外周”药物如奥昔布宁或氟喹诺酮类药物也有涉及。药物治疗的合理化是预防认知障碍和谵妄的关键；大多数致病药物都在负面清单中（如Beers清单），应被有正面标注的药物取代（如依据FORTA分类）。除了治疗谵妄的其他可改变病因（如脱水、感染和发热）外，避免或至少优化精神药物处方是预防老年人认知障碍的关键要素。
