抗胆碱能/镇静药物负担预测 2 型糖尿病的老年不同种族/民族患者的记忆获得更差。
Anticholinergic/sedative drug burden predicts worse memory acquisition in older racially/ethnically diverse patients with type 2 diabetes mellitus.
机构信息
Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI.
Rhode Island Hospital, Providence, RI.
出版信息
Int J Geriatr Psychiatry. 2019 Oct;34(10):1545-1554. doi: 10.1002/gps.5173. Epub 2019 Jul 22.
OBJECTIVE
Anticholinergic/sedative drug use, measured by the Drug Burden Index (DBI), is linked to cognitive impairment in older adults. Yet, studies on the DBI's association with neuropsychological functioning are lacking, especially in underserved groups at increased risk of cognitive impairment. We examined cross-sectional relationships between total DBI (DBI ) and an age-adjusted analogue (Adj DBI ) with the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) in diverse adults with type 2 diabetes mellitus (T2DM). Based on results of a prior study, we anticipated higher DBIs would be associated with worse memory at older ages.
METHODS
One hundred five adults with T2DM (age = 57 ± 9 years, 65% female, 62% Black, 27% Hispanic/Latino, Hb = 7.8 ± 1.8) participated. Although memory outcomes were normally distributed, DBI values were positively skewed. Spearman correlations assessed their bivariate relationships with RBANS. Adjusting for comorbidities, polypharmacy, Hb , and education, we tested the moderating effect of age on DBI-RBANS associations at mean ±1 standard deviations of age.
RESULTS
One third of the participants endorsed current sedative/anticholinergic use. Mean DBI was 0.385, and mean Adj DBI was 0.393 (ranges = 0.00-4.22). Drug burden negatively correlated with RBANS Immediate Memory (DBI r = -0.237, P = .013; Adj DBI r = -0.239, P = .014) but no other indices. There was a significant DBI*Age interaction; the negative effect of drug burden on Immediate Memory was significant for ages greater than or equal to 55 years old.
CONCLUSIONS
Sedative/anticholinergic drug exposure was prevalent in these diverse T2DM patients. Adjusting for covariates, greater drug burden was associated with worse memory acquisition among older adults only. Prospective studies should examine these relationships over time and assess whether dementia biomarkers affect the interaction.
目的
通过药物负担指数（DBI）测量的抗胆碱能/镇静药物的使用与老年人的认知障碍有关。然而，关于 DBI 与神经心理学功能的关联的研究还很缺乏，特别是在认知障碍风险增加的服务不足的人群中。我们研究了不同类型 2 型糖尿病（T2DM）成年人中总 DBI（DBI）和年龄调整模拟物（Adj DBI）与重复认知评估电池（RBANS）之间的横断面关系。基于先前研究的结果，我们预计更高的 DBI 值与年龄较大时的记忆障碍有关。
方法
105 名患有 T2DM 的成年人（年龄=57±9 岁，65%女性，62%黑人，27%西班牙裔/拉丁裔，Hb=7.8±1.8）参与了研究。虽然记忆结果呈正态分布，但 DBI 值呈正偏态分布。Spearman 相关性评估了它们与 RBANS 的双变量关系。在调整合并症、多药治疗、Hb 和教育因素后，我们测试了年龄对 DBI-RBANS 关联在年龄的平均值±1 个标准差的调节作用。
结果
三分之一的参与者目前有镇静/抗胆碱能药物的使用。平均 DBI 为 0.385，平均 Adj DBI 为 0.393（范围=0.00-4.22）。药物负担与 RBANS 即时记忆呈负相关（DBI r=-0.237，P=0.013；Adj DBI r=-0.239，P=0.014），但与其他指数无关。DBI*年龄的交互作用具有统计学意义；药物负担对即时记忆的负面影响在年龄大于或等于 55 岁时才显著。
结论
在这些不同的 T2DM 患者中，镇静/抗胆碱能药物的暴露很常见。在调整了混杂因素后，只有在老年人中，药物负担越大，记忆获得能力越差。前瞻性研究应随着时间的推移检查这些关系，并评估痴呆生物标志物是否会影响这种相互作用。
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