Larson E B, Kukull W A, Buchner D, Reifler B V
Ann Intern Med. 1987 Aug;107(2):169-73. doi: 10.7326/0003-4819-107-2-169.
Adverse drug reactions causing cognitive impairment are an important problem in the elderly. Thirty-five patients with adverse drug reaction were identified among more than 300 patients evaluated for cognitive impairment and compared with patients without adverse drug reaction. Sedative hypnotic agents, especially long-acting benzodiazepines, were the commonest drugs associated with cognitive impairment in this population. The number of drugs used, use of sedative hypnotics and antihypertensives, and falling were strongly associated with adverse reactions in logistic regression analyses. The relative odds of an adverse reaction associated with cognitive impairment increased as the number of prescription drugs increased, exceeding 9.0 for patients taking four or more prescription drugs. Adverse drug reactions are an important source of excess morbidity in patients with dementia or suspected dementia. Strategies that could minimize this problem include a high index of suspicion, drug-free trials in suspected cases, and careful monitoring of drug therapy.
药物不良反应导致认知障碍是老年人中的一个重要问题。在300多名接受认知障碍评估的患者中，识别出35名药物不良反应患者，并与无药物不良反应的患者进行比较。镇静催眠药，尤其是长效苯二氮䓬类药物，是该人群中与认知障碍相关的最常见药物。在逻辑回归分析中，用药数量、使用镇静催眠药和抗高血压药以及跌倒与不良反应密切相关。与认知障碍相关的不良反应的相对几率随着处方药数量的增加而增加，服用四种或更多处方药的患者超过9.0。药物不良反应是痴呆症或疑似痴呆症患者发病率过高的一个重要来源。可以将这个问题最小化的策略包括高度怀疑、对疑似病例进行停药试验以及仔细监测药物治疗。
