Departments of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France; Faculty of MedicineEA 3797, University of Reims Champagne-Ardenne, Reims, France.
Departments of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France.
Am J Geriatr Psychiatry. 2018 Mar;26(3):280-288. doi: 10.1016/j.jagp.2017.08.005. Epub 2017 Aug 14.
The aim of this study was to evaluate the impact of a reduction of the anticholinergic burden (AB) on the frequency and severity of behavioral and psychological symptoms of dementia (BPSD) and their repercussions on the care team (occupational disruptiveness).
In this prospective, single-center study in an acute care unit for Alzheimer disease (AD) and related disorders, 125 elderly subjects (mean age: 84.4 years) with dementia presented with BPSD. The reduction of the AB was evaluated by the Anticholinergic Cognitive Burden Scale. BPSD were evaluated with the Neuropsychiatric Inventory-Nursing Home Version (NPI-NH). The effect of the reduction of the AB on the BPSD was studied using logistic regression adjusting for the variables of the comprehensive geriatric assessment.
Seventy-one subjects (56.8%) presenting with probable AD, 32 (25.6%) mixed dementia (AD and vascular), 17 (13.6%) vascular dementia, and 5 (4.0%) Lewy body dementia were included. Reducing the AB by at least 20% enabled a significant decrease in the frequency × severity scores of the NPI-NH (adjusted odds ratio: 3.5; 95% confidence interval: 1.6-7.9) and of the occupational disruptiveness score (adjusted odds ratio: 9.9; 95% confidence interval: 3.6-27.3).
AB reduction in elderly subjects with dementia makes is possible to reduce BPSD and caregiver burden. Recourse to treatments involving an AB must be avoided as much as possible in these patients, and preferential use of nonpharmacologic treatment management plans is encouraged.
本研究旨在评估减少抗胆碱能负担（AB）对痴呆患者行为和心理症状（BPSD）的频率和严重程度的影响，以及对护理团队（职业干扰）的影响。
在这项针对阿尔茨海默病（AD）和相关疾病的急性护理单元的前瞻性、单中心研究中，125 名患有痴呆症且出现 BPSD 的老年患者（平均年龄：84.4 岁）。通过抗胆碱能认知负担量表评估 AB 的减少情况。使用神经精神科住院患者版神经心理问卷（NPI-NH）评估 BPSD。使用逻辑回归调整综合老年评估的变量，研究减少 AB 对 BPSD 的影响。
71 名患者（56.8%）患有可能的 AD，32 名（25.6%）患有混合性痴呆（AD 和血管性），17 名（13.6%）患有血管性痴呆，5 名（4.0%）患有路易体痴呆。减少 AB 至少 20%可显著降低 NPI-NH 的频率×严重程度评分（调整后的优势比：3.5；95%置信区间：1.6-7.9）和职业干扰评分（调整后的优势比：9.9；95%置信区间：3.6-27.3）。
减少痴呆老年患者的 AB 可降低 BPSD 和护理人员负担。在这些患者中，应尽可能避免使用涉及 AB 的治疗方法，并鼓励优先使用非药物治疗管理计划。
