Loggia Gilles, Attoh-Mensah Elpidio, Pothier Kristell, Morello Rémy, Lescure Pascale, Bocca Marie-Laure, Marcelli Christian, Chavoix Chantal
Normandie Univ, UNICAEN, INSERM, COMETE, Caen, France.
Department of Geriatrics, Normandie Univ, UNICAEN, CHU de Caen Normandie, Caen, France.
Front Pharmacol. 2020 Jan 30;10:1659. doi: 10.3389/fphar.2019.01659. eCollection 2019.
With their broad spectrum of action, psychotropic drugs are among the most common medications prescribed to the elderly. Consequently, the number of older adults taking multiple psychotropic drugs has more than doubled over the last decade. To improve knowledge about the deleterious effects of psychotropic polypharmacy, we investigated whether there is a threshold number of psychotropic molecules that could lead to impairment of global cognition, executive function, or mobility. Furthermore, relationships between the number of psychotropic molecules and cognitive and mobility impairment were examined.
Cross-sectional study.
University Hospital of Caen (France) and advertisements in medical offices.
Community-dwelling older adults 55 years and older (n = 177; 69.8 ± 9.3 years; 81% women).
Number of psychotropic molecules taken daily, global cognition assessed with the Mini Mental State Examination (MMSE) and the Montreal Cognitive Assessment (MoCA), processing speed with the Trail Making Test (TMT) A, executive function with the TMT B and TMT B-A, and mobility with the Time Up and Go (TUG). The threshold numbers of psychotropic molecules were determined by ROC curves analysis. Based on these threshold values, multinomial logistic regression adjusting for covariates was then performed.
Logistic regressions showed that the threshold of two daily psychotropic molecules, identified by the ROC curves analysis, increases the risk of impaired executive function ( = .05 and.005 for the TMT B and TMT B-A, respectively), global cognition ( = .006 and.001 for the MMSE and MoCA, respectively), and mobility ( = .005 for the TUG), independent of confounding factors, including comorbidities. Furthermore, psychotropic polypharmacy would affect mobility through executive functions.
Impairment of global cognition, executive function, and mobility when as few as two psychotropic molecules are consumed in relatively healthy young older adults should alert physicians when prescribing combinations of psychotropic medications.
精神药物作用广泛，是开给老年人最常用的药物之一。因此，在过去十年中，服用多种精神药物的老年人数量增加了一倍多。为了增进对精神药物多药联用有害影响的认识，我们研究了是否存在一个精神药物分子数量阈值，可导致整体认知、执行功能或行动能力受损。此外，还研究了精神药物分子数量与认知及行动能力受损之间的关系。
横断面研究。
法国卡昂大学医院及在医疗机构张贴广告招募。
55岁及以上的社区居住老年人（n = 177；69.8 ± 9.3岁；81%为女性）。
每日服用的精神药物分子数量、用简易精神状态检查表（MMSE）和蒙特利尔认知评估量表（MoCA）评估整体认知、用连线测验A（TMT A）评估处理速度、用连线测验B（TMT B）和连线测验B-A评估执行功能、用起立行走测试（TUG）评估行动能力。通过ROC曲线分析确定精神药物分子的阈值数量。然后基于这些阈值进行调整协变量的多项逻辑回归分析。
逻辑回归分析显示，经ROC曲线分析确定的每日两种精神药物分子的阈值，会增加执行功能受损风险（TMT B和TMT B-A的P值分别为0.05和0.005）、整体认知受损风险（MMSE和MoCA的P值分别为0.006和0.001）及行动能力受损风险（TUG的P值为0.005），且不受包括共病在内的混杂因素影响。此外，精神药物多药联用会通过执行功能影响行动能力。
在相对健康的老年人群中，当每日服用低至两种精神药物分子时就出现整体认知、执行功能及行动能力受损，这应提醒医生在开具精神药物组合处方时加以注意。
