Women's College Research Institute, Women's College Hospital, 76 Grenville Street, Toronto, ON, M5S 1B2, Canada.
Department of Medicine, University of Toronto, Room 2109, 1 King's College Circle, Medical Sciences Building, Toronto, ON, M5S 1A8, Canada.
Drugs Aging. 2019 Sep;36(9):875-884. doi: 10.1007/s40266-019-00690-9.
Cholinesterase inhibitors (ChEIs) are one of only two drug therapies available to manage cognitive decline in dementia. Given sex-specific differences in medication access and effects, it is important to understand how ChEIs are used by women and men.
The objective of this study was to provide contemporary sex-stratified evidence on patterns of ChEI use by community-dwelling older adults with dementia to inform opportunities to optimize drug prescribing.
We conducted a population-based cross-sectional study examining ChEI use in older adults with dementia in Ontario, Canada. We identified all community-dwelling individuals aged 66 years and older with a pre-existing diagnosis of dementia as of 1 April, 2016. We examined the prevalence of ChEI use among women and men separately, and explored the association between ChEI use and age, sex, income status, geographic location of residence, use of palliative care services, comorbidity, and polypharmacy. Concurrent use of drugs known to impair cognition (including antipsychotics, benzodiazepines, and medications with strong anticholinergic properties) was separately assessed among women and men using multivariable analyses and prevalence risk ratios.
Of 74,799 women and 52,231 men living with dementia in the community, nearly 30% currently were using a ChEI (29.3% women, 28.6% men). Close to 70% of users were receiving the target therapeutic dose. Compared to men, women were less often taking the target therapeutic dose (67.8% women vs. 71.6% men, p < 0.001). Over 20% of users also were using drugs known to impair cognition, while being treated for cognitive decline using ChEIs. Compared to men, women were more often concurrently using drugs known to impair cognition (23.9% women vs. 21.8% men, p < 0.001).
This is one of the first studies of ChEI use to account for important sex differences. The results remind clinicians and researchers that patterns of ChEI therapy use differ by sex, as women were less likely to receive target therapeutic doses and more vulnerable to potentially problematic polypharmacy than men.
胆碱酯酶抑制剂（ChEIs）是仅有的两种可用于治疗痴呆症认知能力下降的药物疗法之一。鉴于药物获取和效果存在性别差异，了解女性和男性如何使用 ChEIs 非常重要。
本研究的目的是提供关于社区居住的痴呆症老年人使用 ChEI 的当代性别分层证据，以提供优化药物处方的机会。
我们进行了一项基于人群的横断面研究，研究了加拿大安大略省社区居住的痴呆症老年人使用 ChEI 的情况。我们确定了截至 2016 年 4 月 1 日，所有年龄在 66 岁及以上且预先存在痴呆症诊断的社区居民。我们分别检查了女性和男性中 ChEI 使用的流行率，并探讨了 ChEI 使用与年龄、性别、收入状况、居住地理位置、姑息治疗服务的使用、合并症和多种药物治疗之间的关联。使用多变量分析和流行风险比分别评估了女性和男性中同时使用已知会损害认知的药物（包括抗精神病药、苯二氮䓬类药物和具有强抗胆碱能特性的药物）的情况。
在社区中患有痴呆症的 74799 名女性和 52231 名男性中，近 30%的人目前正在使用 ChEI（29.3%的女性，28.6%的男性）。近 70%的使用者正在接受目标治疗剂量。与男性相比，女性接受目标治疗剂量的可能性较小（67.8%的女性与 71.6%的男性相比，p < 0.001）。超过 20%的使用者还在使用已知会损害认知的药物，同时接受 ChEIs 治疗认知能力下降。与男性相比，女性更常同时使用已知会损害认知的药物（23.9%的女性与 21.8%的男性相比，p < 0.001）。
这是首批考虑重要性别差异的 ChEI 使用研究之一。研究结果提醒临床医生和研究人员，ChEI 治疗的使用模式存在性别差异，女性接受目标治疗剂量的可能性较小，而且比男性更容易出现潜在的有问题的多种药物治疗。
