Department of Geriatric Medicine, Oslo University Hospital, Norway.
J Gerontol A Biol Sci Med Sci. 2013 Mar;68(3):271-8. doi: 10.1093/gerona/gls176. Epub 2012 Sep 14.
Observational studies report a relationship between anticholinergic drug scale (ADS) score and cognitive function. This study investigated whether a reduced ADS score improved cognitive function in a frail elderly population.
This randomized, controlled, single-blinded trial, recruited long-term residents with an ADS score of greater than or equal to 3 from 22 nursing homes in Norway. The participants were randomly allocated (1:1) to intervention or control. The intervention was a pharmacist-initiated reduction of ADS score after multidisciplinary drug reviews. Primary end point was Consortium to Establish a Registry for Alzheimer's Disease 10-wordlist test for immediate recall. Secondary end points were Mini-Mental Sate Examination, delayed recall and recognition of words, saliva flow, and serum anticholinergic activity (SAA).The participants were retested after 4 and 8 weeks, and the study groups were compared after adjusting for baseline differences.
Eighty-seven patients were included. The median ADS score was reduced by 2 units (p < .0001) in the intervention group and remained unchanged in the control group. After 8 weeks, the adjusted mean difference in immediate recall was 0.54 words between the intervention and control group (95% confidence interval [CI]: -0.91, 2.05; p = .48). The study groups did not differ significantly in any of the other cognitive end points, salvia flow, or SAA at either follow-up (p > .18).
Pharmacist-initiated drug changes significantly reduced ADS score but did not improve cognitive function in nursing home residents. Moreover, the drug changes did not reduce SAA or mouth dryness significantly, which might indicate limited applicability of the ADS score to prevent prescription risks in this population.
观察性研究报告称，抗胆碱能药物量表（ADS）评分与认知功能之间存在关系。本研究调查了在虚弱的老年人群中，降低 ADS 评分是否能改善认知功能。
这是一项随机、对照、单盲试验，从挪威的 22 家养老院中招募了 ADS 评分大于或等于 3 的长期居民。参与者被随机分配（1:1）到干预组或对照组。干预措施是在多学科药物评估后，由药剂师启动 ADS 评分降低。主要终点是 Consortium to Establish a Registry for Alzheimer's Disease 10 词列表测试的即时回忆。次要终点是简易精神状态检查、单词延迟回忆和识别、唾液流量和血清抗胆碱能活性（SAA）。参与者在 4 周和 8 周后进行了复测，在调整了基线差异后对研究组进行了比较。
共纳入 87 名患者。干预组的 ADS 评分中位数降低了 2 个单位（p <.0001），而对照组则保持不变。8 周后，干预组和对照组之间即时回忆的调整平均差异为 0.54 个单词（95%置信区间[CI]：-0.91，2.05；p =.48）。在任何其他认知终点、唾液流量或 SAA 方面，两组在任何一次随访时均无显著差异（p >.18）。
药剂师启动的药物改变显著降低了 ADS 评分，但未能改善养老院居民的认知功能。此外，药物改变并未显著降低 SAA 或口干，这可能表明 ADS 评分在预防该人群的处方风险方面的适用性有限。
