Mental Health for Older Adults and Dementia Clinical Academic Group, South London and Maudsley NHS Foundation Trust, London, UK.
Institute of Psychiatry, Psychology and Neuroscience, London, UK.
Int J Geriatr Psychiatry. 2020 Sep;35(9):1069-1077. doi: 10.1002/gps.5330. Epub 2020 May 20.
To investigate associations between central anticholinergic burden (determined through the anticholinergic effect on cognition [AEC] scale) and mortality, hospitalisation and cognitive decline in patients with dementia.
The South London and Maudsley NHS Foundation Trust (SLaM) Clinical Records Interactive Search (CRIS) application was used to identify patients with a first diagnosis of dementia. Medication exposure was extracted through a natural language processing algorithm, allowing for calculations and comparisons of AEC scores. Data were linked to national mortality and hospitalisation data sources, and serially recorded Mini-Mental State Examination (MMSE) scores were used to investigate cognitive decline.
We identified 14 093 patients with dementia, 60.7% were female and the mean age at diagnosis was 79.8 years. Patients for whom a review of their medication was indicated (AEC score ≥ 2 for any individual drug or total AEC score ≥ 3) had an increased risk of mortality (hazard ratio 1.07; 95% confidence interval [CI]: 1.01-1.15) and emergency hospitalisation (1.10; 95% CI: 1.04-1.17), but there were no associations with duration of hospitalisation. Cognitive trajectory analyses showed that this exposure group had lower MMSE scores at diagnosis and a sharper increase in MMSE scores over the subsequent 6 months, but similar slopes for the 6 to 36 months period compared to the remainder of the sample.
Patients with dementia receiving medication with high central anticholinergic activity appear to have worse prognosis in terms of mortality and hospitalisation risk, but have, primarily, acutely impaired cognitive function, rather than longer-term differences in cognitive decline. J Am Geriatr Soc 68:-, 2020.
研究中枢抗胆碱能负担（通过认知抗胆碱能效应量表[AEC]确定）与痴呆患者的死亡率、住院率和认知能力下降之间的关系。
使用南伦敦和莫兹利国民保健信托基金会（SLaM）临床记录互动搜索（CRIS）应用程序来确定首次诊断为痴呆的患者。通过自然语言处理算法提取药物暴露情况，允许计算和比较 AEC 评分。将数据与国家死亡率和住院率数据源进行链接，并连续记录迷你精神状态检查（MMSE）评分以调查认知能力下降情况。
我们确定了 14093 名痴呆患者，其中 60.7%为女性，诊断时的平均年龄为 79.8 岁。对于那些需要审查其药物治疗的患者（任何一种药物的 AEC 评分≥2 或总 AEC 评分≥3），其死亡率（危险比 1.07；95%置信区间[CI]：1.01-1.15）和急诊住院率（1.10；95%CI：1.04-1.17）均升高，但与住院时间无关联。认知轨迹分析表明，该暴露组在诊断时的 MMSE 评分较低，且在随后的 6 个月内 MMSE 评分的增加更为明显，但与样本其余部分相比，6 至 36 个月期间的斜率相似。
接受具有较高中枢抗胆碱能活性的药物治疗的痴呆患者，在死亡率和住院风险方面的预后似乎较差，但主要表现为急性认知功能障碍，而不是认知能力下降的长期差异。美国老年医学会 68 卷：-，2020 年。
