Kersten Hege, Wyller Torgeir Bruun
Old Age Psychiatry Research Network, Telemark Hospital Trust and Vestfold Hospital Trust, Skien, Norway.
Basic Clin Pharmacol Toxicol. 2014 Feb;114(2):151-9. doi: 10.1111/bcpt.12140. Epub 2013 Oct 19.
Concurrent use of several drugs with potential anticholinergic properties is highly prevalent in the elderly. Methods to determine the overall anticholinergic drug burden have been developed to estimate the risk of central anticholinergic adverse effects. The objective of this MiniReview was to critically appraise the clinical utility of the methods used to assess the anticholinergic drug burden in older people's brain. We evaluated the in vitro method used to measure the anticholinergic activity in a patient's serum and the four anticholinergic drug scales: Anticholinergic Risk Scale, Anticholinergic Cognitive Burden, Drug Burden Index and Anticholinergic Drug Scale. Medline searches of the literature from January 1988 to January 2013 were performed. Studies that related anticholinergic drug burden to central adverse outcomes in elderly people were included, while case reports and studies of single substances were excluded. Despite the consistently reported association between a high anticholinergic drug burden and negative cognitive and psychomotor outcomes in older patients, there are discrepancies in the literature. Furthermore, no significant cognitive improvements after the anticholinergic drug burden was reduced have been shown in randomized controlled trials. It is reasonable to question whether the estimated anticholinergic drug burden can predict the overall brain effects of multiple anticholinergic agents in older people.
在老年人中，同时使用几种具有潜在抗胆碱能特性的药物极为普遍。已开发出确定总体抗胆碱能药物负担的方法，以估计中枢抗胆碱能不良反应的风险。本综述的目的是严格评估用于评估老年人脑内抗胆碱能药物负担的方法的临床实用性。我们评估了用于测量患者血清中抗胆碱能活性的体外方法以及四种抗胆碱能药物量表：抗胆碱能风险量表、抗胆碱能认知负担量表、药物负担指数和抗胆碱能药物量表。对1988年1月至2013年1月的文献进行了Medline检索。纳入了将抗胆碱能药物负担与老年人中枢不良结局相关联的研究，而排除了病例报告和单一物质的研究。尽管一直有报道称老年患者抗胆碱能药物负担高与负面认知和精神运动结局之间存在关联，但文献中仍存在差异。此外，在随机对照试验中，抗胆碱能药物负担降低后并未显示出明显的认知改善。质疑估计的抗胆碱能药物负担是否能够预测多种抗胆碱能药物对老年人脑的总体影响是合理的。
