Mate Karen E, Kerr Karen P, Pond Dimity, Williams Evan J, Marley John, Disler Peter, Brodaty Henry, Magin Parker J
School of Biomedical Sciences and Pharmacy, University of Newcastle, Callaghan, NSW, 2308, Australia,
Drugs Aging. 2015 Feb;32(2):159-67. doi: 10.1007/s40266-014-0230-0.
Elderly people, particularly those with dementia, are sensitive to adverse anticholinergic drug effects. This study examines the prevalence of anticholinergic medication, and anticholinergic load and its predictors, in community-dwelling elderly patients (aged 75 years and older) in Australia.
A research nurse visited the home of each participant (n = 1,044), compiled a list of current medications, and assessed participants' cognitive status using a subsection of the revised Cambridge Examination for Mental Disorders of the Elderly (CAMCOG-R). Anticholinergic load was determined for each patient using the Anticholinergic Drug Scale (ADS).
Multivariate analysis identified several patient factors that were associated with higher anticholinergic burden, including polypharmacy (i.e. taking five or more medications) (p < 0.001), increasing age (p = 0.018), CAMCOG-R dementia (p = 0.003), depression (p = 0.003), and lower physical quality of life (p < 0.001). The dementia group (n = 86) took a significantly higher number of medications (4.6 vs. 3.9; p = 0.04), and had a significantly higher anticholinergic load (1.5 vs. 0.8; p = 0.002) than those without dementia (n = 958). Approximately 60% of the dementia group and 40% of the non-dementia group were receiving at least one anticholinergic drug. This difference was due to the higher proportion of dementia patients taking level 1 (potentially anticholinergic) (p = 0.002) and level 3 (markedly anticholinergic) (p = 0.005) drugs.
There is considerable scope for the improvement of prescribing practices in the elderly, and particularly those with dementia. Importantly, level 1 anticholinergics have been identified as major contributors to the anticholinergic load in people with dementia. Longitudinal studies are required to determine the effects of increased and decreased anticholinergic load on cognitive function and other clinical outcomes for people with dementia.
老年人，尤其是患有痴呆症的老年人，对抗胆碱能药物的不良反应较为敏感。本研究调查了澳大利亚社区居住的老年患者（75岁及以上）中抗胆碱能药物的使用情况、抗胆碱能负荷及其预测因素。
研究护士走访了每位参与者（n = 1044）的家中，编制了当前用药清单，并使用修订版的老年人精神障碍剑桥检查（CAMCOG-R）的一个子部分评估参与者的认知状态。使用抗胆碱能药物量表（ADS）确定每位患者的抗胆碱能负荷。
多变量分析确定了几个与较高抗胆碱能负担相关的患者因素，包括多重用药（即服用五种或更多药物）（p < 0.001）、年龄增长（p = 0.018）、CAMCOG-R痴呆（p = 0.003）、抑郁症（p = 0.003）和较低的身体生活质量（p < 0.001）。痴呆症组（n = 86）服用的药物数量明显更多（4.6对3.9；p = 0.04），抗胆碱能负荷也明显更高（1.5对0.8；p = 0.002），高于非痴呆症组（n = 958）。痴呆症组约60%和非痴呆症组约40%的患者正在接受至少一种抗胆碱能药物治疗。这种差异是由于服用1级（潜在抗胆碱能）（p = 0.002）和3级（明显抗胆碱能）（p = 0.005）药物的痴呆症患者比例较高。
老年患者，尤其是患有痴呆症的患者，在处方实践方面有很大的改进空间。重要的是，已确定1级抗胆碱能药物是痴呆症患者抗胆碱能负荷的主要贡献因素。需要进行纵向研究以确定抗胆碱能负荷增加和减少对痴呆症患者认知功能和其他临床结局的影响。
