Cross Amanda J, George Johnson, Woodward Michael C, Ames David, Brodaty Henry, Wolfe Rory, Connors Michael H, 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.
J Alzheimers Dis. 2017;60(2):349-358. doi: 10.3233/JAD-170265.
There is limited evidence regarding the association between potentially inappropriate medications (PIM) and mortality in older people with cognitive impairment.
To examine whether use of medications considered to be potentially inappropriate in older people with cognitive impairment (PIMcog) and anticholinergic cognitive burden (ACB) were associated with mortality in people who attended memory clinics.
Cross-sectional and longitudinal analyses of data from the Prospective Research In MEmory clinics (PRIME) study. Participants were community-dwelling people who attended nine memory clinics and had a diagnosis of mild cognitive impairment or dementia. PIMcog was defined as any medication considered potentially inappropriate for a person with cognitive impairment according to Beers or STOPP criteria. Anticholinergic burden was calculated using the ACB scale. Time-dependent Cox-proportional hazards regression was used to analyze associations between PIMcog use/ACB score and all-cause mortality over a three-year follow-up period. The regression model included the baseline variables: age, gender, education, cognitive diagnoses, total number of medications, disease-burden, cognition, physical function, and neuropsychiatric symptoms.
Of 964 participants, 360 (37.3%) used one or more PIMcog at some time during the study; most commonly anticholinergics and sedatives. 624 (64.7%) participants used a medication with potential or definite anticholinergic properties (ACB>0) at some point during the study. Both PIMcog use (adjusted hazard ratio: 1.42 95% CI: 1.12-1.80) and ACB score (adjusted hazard ratio: 1.18 95% CI: 1.06-1.32) were associated with mortality.
Use of PIMcogs and medications with anticholinergic properties was common among memory clinic patients and both were associated with mortality.
关于潜在不适当用药（PIM）与认知障碍老年人死亡率之间的关联，证据有限。
探讨在认知障碍老年人中被认为潜在不适当的药物（PIMcog）的使用以及抗胆碱能认知负担（ACB）是否与就诊于记忆门诊的患者的死亡率相关。
对来自记忆门诊前瞻性研究（PRIME）的数据进行横断面和纵向分析。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人群。PIMcog被定义为根据Beers或STOPP标准被认为对认知障碍患者潜在不适当的任何药物。使用ACB量表计算抗胆碱能负担。采用时间依赖性Cox比例风险回归分析在三年随访期内PIMcog使用/ACB评分与全因死亡率之间的关联。回归模型纳入了基线变量：年龄、性别、教育程度、认知诊断、用药总数、疾病负担、认知、身体功能和神经精神症状。
在964名参与者中，360名（37.3%）在研究期间的某个时间使用了一种或多种PIMcog；最常见的是抗胆碱能药物和镇静剂。624名（64.7%）参与者在研究期间的某个时间使用了具有潜在或明确抗胆碱能特性（ACB>0）的药物。PIMcog的使用（调整后风险比：1.42，95%置信区间：1.12 - 1.80）和ACB评分（调整后风险比：1.18，95%置信区间：1.06 - 1.32）均与死亡率相关。
在记忆门诊患者中，PIMcog和具有抗胆碱能特性的药物的使用很常见，且两者均与死亡率相关。
