King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK; Department of Geriatric Medicine, Bezmialem Vakif University, Faculty of Medicine, Istanbul, Turkey.
King's College London, Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Exp Gerontol. 2019 Jun;120:62-67. doi: 10.1016/j.exger.2019.02.019. Epub 2019 Mar 1.
Polypharmacy, defined through the number of medications prescribed, has been linked to a range of adverse health outcomes in people with dementia. It is however unclear whether a numerical threshold of concurrently prescribed drugs is a suitable predictor for cognitive decline. We aimed to test associations between polypharmacy and both short-term (six months) and long-term (three years) cognitive trajectories in patients with incident dementia. Using data from a large mental health and dementia care database in South London, a cohort of 12,148 patients (mean age = 80.7 years, 61.1% female, mean MMSE = 18.6) clinically diagnosed with dementia was identified. We determined the number of medications prescribed at dementia diagnosis and defined two exposure groups: polypharmacy (5-9 medication) and excessive polypharmacy (≥10 medications), with 0-4 medications as reference group. All Mini Mental State Examination (MMSE) scores between one year before and three years after dementia diagnosis were ascertained. Effects of polypharmacy on cognitive decline were studied using Generalized Additive Models for Location, Scale and Shape and Linear Mixed Estimation Models. At the time of dementia diagnosis polypharmacy was present in 3503 (28.8%) patients and excessive polypharmacy in 1235 (10.2%) patients. In all three groups MMSE scores initially improved after dementia diagnosis and further decline was detected in the time interval from six months to three years after dementia diagnosis. No significant differences to the control group were found in relation to polypharmacy or excessive polypharmacy, neither in the initial cognitive improvement nor long-term decline. In conclusion, polypharmacy defined by the number of drugs does not appear to predict cognitive decline in a naturalistic cohort of patients with dementia. More sophisticated tools, considering appropriateness of prescribing and the clinical picture, might be better placed to evaluate cognitive outcomes in dementia and to make practice and research recommendations.
药物疗法过多，定义为开具的药物数量，与痴呆患者的一系列不良健康结果有关。然而，目前尚不清楚同时开具的药物数量是否是认知能力下降的合适预测指标。我们旨在检验药物疗法过多与痴呆患者短期（6 个月）和长期（3 年）认知轨迹之间的关联。使用来自伦敦南部一个大型精神卫生和痴呆症护理数据库的数据，我们确定了 12148 名（平均年龄 80.7 岁，61.1%为女性，平均 MMSE 评分为 18.6）确诊为痴呆的患者队列。我们确定了在痴呆诊断时开具的药物数量，并定义了两个暴露组：药物疗法过多（5-9 种药物）和药物疗法过多（≥10 种药物），0-4 种药物为参照组。在痴呆诊断前一年到诊断后三年之间，我们确定了所有的简易精神状态检查（MMSE）评分。使用位置、规模和形状的广义加性模型和线性混合估计模型研究药物疗法过多对认知能力下降的影响。在痴呆诊断时，有 3503 名（28.8%）患者存在药物疗法过多，1235 名（10.2%）患者存在药物疗法过多。在所有三组中，MMSE 评分在痴呆诊断后最初有所改善，在痴呆诊断后 6 个月至 3 年内进一步下降。在初始认知改善和长期下降方面，与对照组相比，药物疗法过多或药物疗法过多均未发现显著差异。总之，用药物数量定义的药物疗法过多似乎不能预测痴呆自然队列患者的认知能力下降。更复杂的工具，考虑到药物的适当性和临床情况，可能更适合评估痴呆患者的认知结果，并为实践和研究提供建议。
