Boccardi V, Baroni M, Paolacci L, Ercolani S, Longo A, Giordano M, Ruggiero C, Mecocci P
Dr Virginia Boccardi, Institute of Gerontology and Geriatrics, Department of Medicine, University of Perugia, S. Andrea delle Fratte, 06156 Perugia, Italy. Phone number: +39 0755783524 Email address:
J Nutr Health Aging. 2017;21(4):389-396. doi: 10.1007/s12603-016-0787-x.
The use of drugs with intrinsic anticholinergic properties is widespread among old age persons. A growing body of evidences suggest that a high anticholinergic burden is associated with physical and cognitive impairment. However, the association between anticholinergic drug use and functional status is still poorly investigated, particularly among subjects with initial cognitive impairment.
Cross-sectional study examining the association between drug-related anticholinergic burden and functional status in cognitively healthy (CH) (n=691), mild cognitive impairment (MCI) (n=541) or mild Alzheimer's diseases (AD) (n=1127) subjects.
Data were gathered from the ReGAl project (Rete Geriatrica Alzheimer-Geriatric Network on Alzheimer's disease), a large longitudinal Italian multicentric clinical-based study, promoted by the Italian Society of Gerontology and Geriatrics (SIGG).
2359 outpatients, older than 65 years, admitted to memory clinics. The total sample size, estimated according to a global effect size of 25% with type I error of 0.05 and a power of 95% is 2010 subjects.
Functional status was evaluated by the Katz Index of Independence in Activities of Daily Living (ADL) and the Lawton-Brody Instrumental Activities of Daily Living (IADL) scales. The drug-related anticholinergic burden was estimated by the Anticholinergic Risk Scale (ARS).
The 15.9 % (n=375) of total population used at least one drug with anticholinergic properties. Such a drug use was associated with partially dependence in ADL (OR:1.42, CI95%: 1.10-1.83; p=0.006), independently of gender, number of drugs, comorbidity index, presence of clinically relevant neuropsychiatric symptoms and adjusted MMSE. Anticholinergic drug use was associated with un-ability at each IADL task only in male MCI subjects, with significant impairment in shopping (p=0.011), and drug management (p=0.05).
The use of medications with anticholinergic properties is common among older persons cognitively health as well as with cognitive impairment. Our results suggest that the use of anticholinergic drugs is associated with functional impairment, especially in old age subjects with initial cognitive impairment. Minimizing anticholinergic burden should result in maintaining daily functioning, especially in a vulnerable population, such as MCI and mild AD.
具有内在抗胆碱能特性的药物在老年人中广泛使用。越来越多的证据表明，高抗胆碱能负担与身体和认知障碍有关。然而，抗胆碱能药物使用与功能状态之间的关联仍研究不足，尤其是在初始认知障碍的受试者中。
横断面研究，调查认知健康（CH）（n = 691）、轻度认知障碍（MCI）（n = 541）或轻度阿尔茨海默病（AD）（n = 1127）受试者中与药物相关的抗胆碱能负担和功能状态之间的关联。
数据来自ReGAl项目（意大利老年痴呆症老年医学网络——关于阿尔茨海默病的老年医学网络），这是一项由意大利老年医学和老年病学会（SIGG）推动的大型纵向意大利多中心临床研究。
2359名65岁以上的门诊患者，入住记忆诊所。根据25%的总体效应量、0.05的I类错误率和95%的检验效能估计的总样本量为2010名受试者。
功能状态通过日常生活活动能力的Katz独立指数（ADL）和Lawton - Brody日常生活活动能力量表（IADL）进行评估。与药物相关的抗胆碱能负担通过抗胆碱能风险量表（ARS）进行估计。
总人口的15.9%（n = 375）使用了至少一种具有抗胆碱能特性的药物。这种药物使用与ADL中的部分依赖相关（OR：1.42，95%CI：1.10 - 1.83；p = 0.006），与性别、药物数量、合并症指数、临床相关神经精神症状的存在以及校正后的MMSE无关。仅在男性MCI受试者中，抗胆碱能药物使用与每项IADL任务的无能力相关，在购物（p = 0.011）和药物管理（p = 0.05）方面有显著损害。
具有抗胆碱能特性的药物在认知健康以及有认知障碍的老年人中使用普遍。我们的结果表明，抗胆碱能药物的使用与功能损害相关，尤其是在初始认知障碍的老年受试者中。尽量减少抗胆碱能负担应有助于维持日常功能，特别是在如MCI和轻度AD等脆弱人群中。
