Cross Amanda J, George Johnson, Woodward Michael C, Ames David, Brodaty Henry, Ilomäki Jenni, Elliott Rohan A
Centre for Medicine Use and Safety, Faculty of Pharmacy and Pharmaceutical Sciences, Monash University, Parkville, VIC, Australia.
Medical and Cognitive Research Unit, Austin Health, Heidelberg, VIC, Australia.
Drugs Aging. 2016 Jan;33(1):37-44. doi: 10.1007/s40266-015-0332-3.
There has been limited research into potentially inappropriate medication (PIM) use and anticholinergic burden in patients attending memory clinics.
The aim of this study was to explore the use of PIMs related to cognitive impairment (PIMcog), anticholinergic cognitive burden (ACB) and concomitant use of anticholinergic medications with cholinesterase inhibitors (ChEIs) in patients attending memory clinics.
Cross-sectional analysis of baseline data from the Prospective Research In MEmory clinics (PRIME) study was performed. Participants were community-dwelling patients who attended nine memory clinics and had a diagnosis of mild cognitive impairment or dementia. PIMcog were defined as any medication considered potentially inappropriate for patients with cognitive impairment according to the Beers or STOPP criteria. Clinically significant ACB was defined as total score of ≥3 on the ACB scale.
A total of 964 patients, mean age 77.6 years, were included. PIMcog were used by 206 (21.4%) patients. Anticholinergics and sedatives were the most common PIMcog. PIMcog use was associated with higher number of medications (adjusted OR 1.26; 95% CI 1.19-1.33) and with not having completed secondary level education (adjusted OR 1.71; 95% CI 1.01-2.89). One hundred and thirteen (11.7%) patients had a clinically significant ACB score (≥3). ChEIs were used by 575 patients and 65 (11.3%) of these had an ACB score ≥3. There was no statistically significant difference in ChEI use between patients with and without an ACB score ≥3.
PIMcog use, clinically significant anticholinergic burden, and concurrent use of anticholinergics with ChEIs were prevalent in patients attending memory clinics. Efforts are needed to improve prescribing for people with cognitive impairment.
针对记忆门诊患者潜在不适当用药（PIM）的使用情况及抗胆碱能负担的研究有限。
本研究旨在探讨记忆门诊患者中与认知障碍相关的PIM（PIMcog）的使用情况、抗胆碱能认知负担（ACB）以及抗胆碱能药物与胆碱酯酶抑制剂（ChEIs）的联合使用情况。
对前瞻性记忆门诊研究（PRIME）的基线数据进行横断面分析。参与者为居住在社区、就诊于9家记忆门诊且被诊断为轻度认知障碍或痴呆的患者。PIMcog被定义为根据Beers标准或STOPP标准，任何被认为对认知障碍患者可能不适当的药物。具有临床意义的ACB被定义为ACB量表总分≥3分。
共纳入964例患者，平均年龄77.6岁。206例（21.4%）患者使用了PIMcog。抗胆碱能药物和镇静剂是最常见的PIMcog。PIMcog的使用与用药数量较多（调整后OR 1.26；95%CI 1.19 - 1.33）以及未完成中等教育（调整后OR 1.71；95%CI 1.01 - 2.89）相关。113例（11.7%）患者的ACB评分具有临床意义（≥3分）。575例患者使用了ChEIs，其中65例（11.3%）的ACB评分≥3分。ACB评分≥3分和<3分的患者在ChEIs使用方面无统计学显著差异。
在记忆门诊患者中，PIMcog的使用、具有临床意义的抗胆碱能负担以及抗胆碱能药物与ChEIs的联合使用情况较为普遍。需要努力改善对认知障碍患者的处方开具。
