Chatterjee Satabdi, Bali Vishal, Carnahan Ryan M, Johnson Michael L, Chen Hua, Aparasu Rajender R
Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, TX, USA.
Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA.
Am J Geriatr Psychiatry. 2016 Jun;24(6):485-95. doi: 10.1016/j.jagp.2015.12.011. Epub 2016 Feb 17.
To examine the risk of dementia with anticholinergic use among elderly nursing home residents with depression.
Population-based nested case-control study.
Population-based study involving 2007-2010 Minimum Data Set-linked Medicare data from all 50 states.
Medicare beneficiaries aged 65 years and older, diagnosed with depression, and no history of dementia as of 2007 (baseline period). Cases were identified as patients with incident dementia following the baseline period. For each case, four age- and sex-matched control subjects were selected using incidence density sampling.
Anticholinergic exposure was defined using Anticholinergic Drug Scale. Prescription of clinically significant anticholinergic medications (levels 2 and 3) 30 days preceding the event date formed the primary exposure. The primary outcome was dementia diagnosis, between January 1, 2008, and December 31, 2010. A conditional logistic regression model stratified on matched case-control sets was performed to assess dementia risk, after controlling for other risk factors.
The study sample included 28,388 cases diagnosed with dementia and 113,352 matched control subjects. After adjusting for other risk factors, clinically significant anticholinergic use was associated with significant risk of dementia (OR: 1.26; 95% CI: 1.22-1.29) compared with non-use. The findings remained consistent across levels of anticholinergic potency (level 2, OR: 1.37, 95% CI: 1.31-1.44; level 3, OR: 1.15, 95% CI: 1.10-1.19).
Use of clinically significant anticholinergic medications was associated with a 26% increase in risk of dementia among elderly nursing home residents with depression. With increasing safety concerns, there is a significant need to optimize anticholinergic use, especially for those who are at risk for dementia.
研究老年疗养院抑郁症患者使用抗胆碱能药物后患痴呆症的风险。
基于人群的巢式病例对照研究。
基于人群的研究，涉及来自美国所有50个州的2007 - 2010年与医疗保险数据集相链接的最低数据集。
2007年（基线期）年龄在65岁及以上、被诊断为抑郁症且无痴呆症病史的医疗保险受益人。病例被确定为基线期后发生痴呆症的患者。对于每个病例，使用发病密度抽样选择四名年龄和性别匹配的对照受试者。
使用抗胆碱能药物量表定义抗胆碱能暴露。事件日期前30天开具的具有临床意义的抗胆碱能药物（2级和3级）处方构成主要暴露因素。主要结局是2008年1月1日至2010年12月31日期间的痴呆症诊断。在控制其他风险因素后，对匹配的病例对照集进行分层的条件逻辑回归模型用于评估痴呆症风险。
研究样本包括28388例被诊断为痴呆症的病例和113352名匹配的对照受试者。在调整其他风险因素后，与未使用抗胆碱能药物相比，使用具有临床意义的抗胆碱能药物与患痴呆症的显著风险相关（比值比：1.26；95%置信区间：1.22 - 1.29）。在抗胆碱能效力的不同水平上，研究结果保持一致（2级，比值比：1.37，95%置信区间：1.31 - 1.44；3级，比值比：1.15，95%置信区间：1.10 - 1.19）。
在老年疗养院抑郁症患者中，使用具有临床意义的抗胆碱能药物与患痴呆症的风险增加26%相关。鉴于安全担忧日益增加，非常有必要优化抗胆碱能药物的使用，特别是对于有患痴呆症风险的人群。
