Lippert Theresa, Maas Renke, Fromm Martin F, Luttenberger Katharina, Kolominsky-Rabas Peter, Pendergrass Anna, Gräßel Elmar
Zentrum für Medizinische Versorgungsforschung, Psychiatrische und Psychotherapeutische Klinik, Universitätsklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg (FAU).
Institut für Experimentelle und Klinische Pharmakologie und Toxikologie, Lehrstuhl für Klinische Pharmakologie und Klinische Toxikologie, Friedrich-Alexander-Universität Erlangen-Nürnberg, Erlangen.
Gesundheitswesen. 2020 Jan;82(1):14-22. doi: 10.1055/a-1071-7911. Epub 2020 Jan 21.
The aims of this study were to create a scale for measuring the sedating and activating effects of drugs and to analyse if the total value of this scale correlates significantly with falls requiring medical treatment in dementia patients. Furthermore, prescription of drugs in nursing homes included in the PRISCUS-List, Anticholinergic Cognitive Burden List (ACB-List) and usage of psychotropic drugs were investigated.
This is a data analysis of a randomized controlled trial which tested the effects of a non-pharmacological multimodal activation therapy (MAKS) in 139 patients with degenerative dementia in 5 nursing homes. At the beginning of the study, all prescribed drugs were rated on a five-tier scale by 2 pharmacologists based on the drugs' sedating or activating effects. The scale ranged from severely activating (+2) to severely sedating (- 2). The "central nervous system (CNS) depressant score" of each patient was calculated by summing up the scale value of all the medications they were taking. The correlation between CNS-depressant score and falls resulting in injuries within an observation period of 12 months was investigated by binary logistic regression analysis.
Nearly 30% of the nursing home residents received drugs listed in the PRISCUS-list, 50% received drugs on the ACB-List, 55% took psychotropic drugs and 66% received at least 5 drugs. Sedating drugs were prescribed to 62% of patients. During the observation period, 36 out of 139 nursing home residents suffered falls and medical treatment was necessary. In multivariate analysis, the CNS-depressant score was associated significantly (p=0.045) with falls with resulting injuries. Increased sedation resulted in a higher number of fall incidents.
The CNS-depressant score is a useful tool to describe the degree of sedation. Due to the significant association between sedation and falls resulting in injuries, the sedating medication of people suffering from dementia should be minimised as much as possible to reduce the risk of undesirable side effects.
本研究的目的是创建一个用于衡量药物镇静和激活作用的量表，并分析该量表的总分是否与痴呆患者需要医疗救治的跌倒事件显著相关。此外，还对纳入PRISCUS清单、抗胆碱能认知负担清单（ACB清单）的养老院药物处方以及精神药物的使用情况进行了调查。
这是一项对随机对照试验的数据分析，该试验在5家养老院对139例退行性痴呆患者测试了非药物多模式激活疗法（MAKS）的效果。在研究开始时，2名药理学家根据药物的镇静或激活作用，采用五级量表对所有处方药物进行评分。该量表范围从强激活（+2）到强镇静（-2）。通过将每位患者所服用的所有药物的量表值相加，计算出每位患者的“中枢神经系统（CNS）抑制评分”。通过二元逻辑回归分析研究CNS抑制评分与12个月观察期内导致受伤的跌倒事件之间的相关性。
近30%的养老院居民服用了PRISCUS清单中的药物，50%的居民服用了ACB清单中的药物，55%的居民服用了精神药物，66%的居民至少服用了5种药物。62%的患者使用了镇静药物。在观察期内，139名养老院居民中有36人跌倒且需要医疗救治。在多变量分析中，CNS抑制评分与导致受伤的跌倒事件显著相关（p = 0.045）。镇静作用增强导致跌倒事件数量增加。
CNS抑制评分是描述镇静程度的有用工具。由于镇静与导致受伤的跌倒事件之间存在显著关联，应尽可能减少痴呆患者的镇静药物使用，以降低不良副作用的风险。
