Purdue University College of Pharmacy, West Lafayette, IN.
Indiana University Center for Aging Research, Regenstrief Institute, Inc., Indianapolis, IN.
Pharmacotherapy. 2018 May;38(5):511-519. doi: 10.1002/phar.2106. Epub 2018 Apr 25.
To determine the influence of anticholinergic medications on transitions in cognitive diagnosis of older adults in primary care.
This observational cohort study was conducted over a mean follow-up of 3.2 years. Anticholinergic exposure was defined by pharmacy dispensing and claims records. Cognitive diagnosis was performed by an expert panel at baseline and annually up to 4 years.
Medication exposure and other clinical data were extracted from the Indiana Network for Patient Care (INPC). The cognitive diagnosis was derived from a cognitive screening and diagnosis study.
A total of 350 adults 65 years and older without dementia and receiving primary care in a safety net health care system.
Cognitive diagnosis followed a two-phase screening and consensus-based neuropsychiatric examination to determine a baseline diagnosis as normal cognition, mild cognitive impairment (MCI), or dementia, with a follow-up neuropsychiatric examination and consensus-based diagnosis repeated annually. The Anticholinergic Cognitive Burden scale was used to identify anticholinergics dispensed up to 10 years before enrollment and annually throughout the study. A total standard daily dose of anticholinergics was calculated by using pharmacy dispensing data from the INPC. Among 350 participants, a total of 978 diagnostic assessments were completed over a mean follow-up of 3.2 years. Compared with stable cognition, increasing use of strong anticholinergics calculated by total standard daily dose increased the odds of transition from normal cognition to MCI (odds ratio [OR] 1.15, 95% confidence interval [CI] 1.01-1.31, p = 0.0342). Compared with stable MCI, strong anticholinergics did not influence the reversion of MCI to normal cognition (OR 0.95, 95% CI 0.86-1.05, p = 0.3266).
De-prescribing interventions in older adults with normal cognition should test anticholinergics as potentially modifiable risk factors for cognitive impairment.
确定抗胆碱能药物对初级保健中老年患者认知诊断转变的影响。
本观察性队列研究的平均随访时间为 3.2 年。通过药房配药和索赔记录来定义抗胆碱能药物的暴露情况。认知诊断由一个专家小组在基线和每年进行，最长可达 4 年。
药物暴露和其他临床数据从印第安纳州患者护理网络（INPC）中提取。认知诊断源自一项认知筛查和诊断研究。
共 350 名年龄在 65 岁及以上、无痴呆且在一个安全网医疗保健系统中接受初级保健的成年人。
认知诊断遵循两阶段筛查和基于共识的神经心理检查，以确定基线诊断为正常认知、轻度认知障碍（MCI）或痴呆，每年重复进行神经心理检查和基于共识的诊断。使用抗胆碱能认知负担量表来确定在入组前 10 年和整个研究期间每年开出处方的抗胆碱能药物。使用 INPC 的药房配药数据计算出总标准每日剂量的抗胆碱能药物。在 350 名参与者中，在平均 3.2 年的随访期间共完成了 978 项诊断评估。与稳定的认知相比，使用总标准每日剂量计算出的强抗胆碱能药物的使用量增加，增加了从正常认知到 MCI 的转变的几率（比值比 [OR] 1.15，95%置信区间 [CI] 1.01-1.31，p = 0.0342）。与稳定的 MCI 相比，强抗胆碱能药物对 MCI 恢复正常认知没有影响（OR 0.95，95% CI 0.86-1.05，p = 0.3266）。
在认知正常的老年患者中进行减药干预时，应将抗胆碱能药物作为认知障碍的潜在可改变的危险因素进行测试。
