Liu Enwu, Dyer Suzanne M, O'Donnell Lisa Kouladjian, Milte Rachel, Bradley Clare, Harrison Stephanie L, Gnanamanickam Emmanuel, Whitehead Craig, Crotty Maria
Department of Rehabilitation, Aged and Extended Care, Faculty of Medicine, Nursing and Health Sciences, School of Health Sciences, Flinders University, Daw Park, Australia.
NHMRC Cognitive Partnership Centre, The University of Sydney, Sydney NSW, Australia.
J Geriatr Cardiol. 2017 Jun;14(6):407-415. doi: 10.11909/j.issn.1671-5411.2017.06.009.
To examine associations between cardiovascular system medication use with cognition function and diagnosis of dementia in older adults living in nursing homes in Australia.
As part of a cross-sectional study of 17 Australian nursing homes examining quality of life and resource use, we examined the association between cognitive impairment and cardiovascular medication use (identified using the Anatomical Therapeutic Classification System) using general linear regression and logistic regression models. People who were receiving end of life care were excluded.
Participants included 541 residents with a mean age of 85.5 years (± 8.5), a mean Psychogeriatric Assessment Scale-Cognitive Impairment (PAS-Cog) score of 13.3 (± 7.7), a prevalence of cardiovascular diseases of 44% and of hypertension of 47%. Sixty-four percent of participants had been diagnosed with dementia and 72% had received cardiovascular system medications within the previous 12 months. Regression models demonstrated the use of cardiovascular medications was associated with lower (better) PAS-Cog scores [Coefficient (β) = -3.7; 95% CI: -5.2 to -2.2; < 0.0001] and a lower probability of a dementia diagnosis (OR = 0.44; 95% CI: 0.26 to 0.75, = 0.0022). Analysis by subgroups of medications showed cardiac therapy medications (C01), beta blocking agents (C07), and renin-angiotensin system agents (C09) were associated with lower PAS-Cog scores (better cognition) and lower dementia diagnosis probability.
This analysis has demonstrated an association between greater cardiovascular system medication use and better cognitive status among older adults living in nursing homes. In this population, there may be differential access to health care and treatment of cardiovascular risk factors. This association warrants further investigation in large cohort studies.
研究澳大利亚养老院老年人心血管系统药物使用与认知功能及痴呆诊断之间的关联。
作为一项对17家澳大利亚养老院进行的生活质量和资源利用横断面研究的一部分，我们使用一般线性回归和逻辑回归模型，研究了认知障碍与心血管药物使用（根据解剖治疗学分类系统确定）之间的关联。接受临终关怀的患者被排除在外。
参与者包括541名居民，平均年龄85.5岁（±8.5），平均老年精神病评估量表-认知障碍（PAS-Cog）评分为13.3（±7.7），心血管疾病患病率为44%，高血压患病率为47%。64%的参与者被诊断患有痴呆症，72%的参与者在过去12个月内使用过心血管系统药物。回归模型显示，使用心血管药物与较低（较好）的PAS-Cog评分相关[系数（β）=-3.7；95%置信区间：-5.2至-2.2；P<0.0001]，且痴呆诊断概率较低（比值比=0.44；95%置信区间：0.26至0.75，P=0.0022）。按药物亚组分析显示，心脏治疗药物（C01）、β受体阻滞剂（C07）和肾素-血管紧张素系统药物（C09）与较低的PAS-Cog评分（更好的认知）和较低的痴呆诊断概率相关。
该分析表明，澳大利亚养老院老年人心血管系统药物使用量增加与认知状态改善之间存在关联。在这一人群中，获得医疗保健和治疗心血管危险因素的机会可能存在差异。这种关联值得在大型队列研究中进一步调查。
