Department of Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, IA, USA.
Alzheimers Dement. 2013 Jul;9(4):377-85. doi: 10.1016/j.jalz.2012.02.005. Epub 2012 Nov 22.
Older Americans are facing an epidemic of chronic diseases and are thus exposed to anticholinergics (ACs) that might negatively affect their risk of developing mild cognitive impairment (MCI) or dementia.
To investigate the association between impairment in cognitive function and previous AC exposure.
A retrospective cohort study.
Primary care clinics in Indianapolis, Indiana.
A total of 3690 older adults who have undergone cognitive assessment and had a 1-year medication-dispensing record.
Cognitive function was measured in two sequential steps: a two-step screening process followed by a formal diagnostic process for participants with positive screening results.
Three patterns of AC exposure were defined by the duration of AC exposure, the number of AC medications dispensed at the same time, and the severity of AC effects as determined by the Anticholinergic Cognitive Burden list.
Compared with older adults with no AC exposure and after adjusting for age, race, gender, and underlying comorbidity, the odds ratio for having a diagnosis of MCI was 2.73 (95% confidence interval, 1.27-5.87) among older adults who were exposed to at least three possible ACs for at least 90 days; the odds ratio for having dementia was 0.43 (95% confidence interval, 0.10-1.81).
Exposure to medications with severe AC cognitive burden may be a risk factor for developing MCI.
美国老年人正面临着慢性病的流行，因此容易接触到可能会增加他们出现轻度认知障碍（MCI）或痴呆风险的抗胆碱能药物（ACs）。
调查认知功能损害与既往 AC 暴露之间的关系。
回顾性队列研究。
印第安纳州印第安纳波利斯市的初级保健诊所。
共纳入 3690 名接受认知评估且有 1 年药物配药记录的老年人。
认知功能通过两步进行测量：对参与者进行两步筛选过程，对筛查阳性的参与者进行正式的诊断过程。
通过 AC 暴露的持续时间、同时开具的 AC 药物数量以及抗胆碱能认知负担清单确定的 AC 效应严重程度，定义了三种 AC 暴露模式。
与无 AC 暴露的老年人相比，在调整年龄、种族、性别和潜在合并症后，至少接触 3 种可能的 AC 药物且暴露时间至少 90 天的老年人，其 MCI 诊断的比值比为 2.73（95%置信区间，1.27-5.87）；痴呆的比值比为 0.43（95%置信区间，0.10-1.81）。
暴露于具有严重 AC 认知负担的药物可能是发生 MCI 的一个危险因素。
