Department of Geriatrics and Internal Medicine, Reims University Hospitals, Maison Blanche Hospital, Reims, France; Faculty of Medicine, EA 3797, University of Reims Champagne-Ardenne, Reims, France.
Epidemiology and infection control unit, University hospital of Dijon, Dijon, France; INSERM U1231, EPICAD Team, Dijon, France.
J Am Med Dir Assoc. 2019 Feb;20(2):159-164.e3. doi: 10.1016/j.jamda.2018.10.015. Epub 2018 Nov 28.
A high anticholinergic burden (AB) is associated with the occurrence of behavioral and psychological symptoms (BPSDs), which are frequent in dementia.
Our aim was to determine the threshold for a reduction in AB that would lead to a clinically significant improvement in BPSDs (in terms of frequency, severity, and disruptiveness).
A single-center prospective study.
Dedicated geriatric care unit specializing in the management of patients with dementia.
The study involved older patients with dementia, hospitalized for management of BPSDs.
One hundred forty-seven patients were included (mean age = 84.1 ± 5.2 years). The AB was assessed using 3 scales, namely, the Anticholinergic Drug Scale (ADS), the Anticholinergic Cognitive Burden scale (ACB), and the Anticholinergic Risk Scale (ARS). A clinically significant improvement in BPSDs was defined as a reduction of 4 points in the frequency × severity (F×S) score of the Neuropsychiatric Inventory-Nursing Home (NPI-NH) questionnaire. The threshold for a reduction in AB that corresponded to a clinically significant improvement in BPSDs was determined by multiple linear regression.
One hundred forty-seven patients were included (mean age = 84.1 ± 5.2 years). Using the ADS, a reduction of 2 points in AB in patients with moderate-intensity BPSDs was associated with a clinically significant improvement in the F×S score of the NPI-NH [6.34, 95% confidence interval (CI) 4.54-8.14], and a reduction of 3 points was associated with a clinically significant improvement in the occupational disruptiveness score (4.26, 95% CI 3.11-5.41).
CONCLUSIONS/IMPLICATIONS: In older patients with dementia presenting BPSDs, the risk-benefit ratio of anticholinergic drugs is debatable and, where possible, drugs with a lower AB would be preferable. Because BPSDs are a frequent cause of hospitalization, a standardized approach to analysis and reduction of AB is warranted in this population. Depending on the scale used to assess anticholinergic burden (AB), a small reduction in AB is associated with a decrease in frequency, severity, and disruptiveness of moderate-intensity BPSDs. Drugs with a high AB should be avoided where possible in older patients with dementia, and drugs with a lower AB would be preferable. Heterogeneity between the assessment scales for AB precludes generalization of the impact of a reduction in AB on BPSDs.
高抗胆碱能负担（AB）与行为和心理症状（BPSD）的发生有关，而 BPSD 在痴呆症中很常见。
我们旨在确定降低 AB 水平以导致 BPSD（在频率、严重程度和破坏性方面）临床显著改善的阈值。
单中心前瞻性研究。
专门从事痴呆症患者管理的老年护理单位。
这项研究涉及因 BPSD 住院管理的老年痴呆症患者。
纳入了 147 名患者（平均年龄 84.1±5.2 岁）。使用 3 种量表评估 AB，即抗胆碱能药物量表（ADS）、抗胆碱能认知负担量表（ACB）和抗胆碱能风险量表（ARS）。神经精神科住院患者护理评估量表（NPI-NH）问卷的频率×严重程度（F×S）评分降低 4 分被定义为 BPSD 的临床显著改善。通过多元线性回归确定与 BPSD 临床显著改善相对应的 AB 降低阈值。
纳入了 147 名患者（平均年龄 84.1±5.2 岁）。使用 ADS，中度强度 BPSD 患者的 AB 降低 2 分与 NPI-NH 的 F×S 评分的临床显著改善相关[6.34，95%置信区间（CI）4.54-8.14]，而 AB 降低 3 分与职业干扰评分的临床显著改善相关[4.26，95%CI 3.11-5.41]。
结论/意义：对于患有 BPSD 的老年痴呆症患者，抗胆碱能药物的风险-获益比值得商榷，在可能的情况下，应选择 AB 较低的药物。由于 BPSD 是住院的常见原因，因此需要对该人群进行 AB 分析和降低的标准化方法。根据用于评估抗胆碱能负担（AB）的量表，AB 的少量降低与中度强度 BPSD 的频率、严重程度和破坏性降低相关。在患有痴呆症的老年患者中，应尽可能避免使用 AB 较高的药物，而 AB 较低的药物则更为可取。AB 评估量表之间的异质性排除了 AB 降低对 BPSD 的影响的可推广性。
