Barthold Douglas, Marcum Zachary A, Chen Shuxian, White Lindsay, Ailabouni Nagham, Basu Anirban, Coe Norma B, Gray Shelly L
The Comparative Health Outcomes, Policy, and Economics (CHOICE) Institute, School of Pharmacy, University of Washington, Seattle, WA, USA.
The Plein Center for Geriatric Pharmacy Research, Education, and Outreach, School of Pharmacy, University of Washington, Seattle, WA, USA.
J Gen Intern Med. 2021 Apr;36(4):863-868. doi: 10.1007/s11606-020-06279-y. Epub 2020 Oct 9.
Medication management requires complex cognitive functioning, and therefore, difficulty taking medications might be an early sign of cognitive impairment and could be a risk factor for Alzheimer's disease and related dementias (ADRD). Accordingly, people with difficulty taking medications may benefit from more detailed cognitive screening, potentially aiding in the diagnosis of ADRD, which is underdiagnosed. We are unaware of evidence on medication management difficulties that precede a real-world ADRD diagnosis in the USA.
Examine the association between difficulty taking medications and subsequent real-world ADRD diagnoses.
Case-control study, using Health and Retirement Study (HRS) survey data linked to Medicare claims.
A total of 1461 HRS respondents with an ADRD diagnosis observed from 1993 to 2012 (cases), matched by year of birth, wave of HRS entry, and sex to 3771 controls with no ADRD diagnosis.
We examined the association between diagnosis of ADRD and self-reported difficulty taking medications in the preceding years (1-2 and 3-4 years prior to case definition). Control individuals were assigned the index date from their matched case. Conditional logistic regressions adjusted for age, sex, race, education, and comorbidities.
Compared with matched controls, cases had higher prevalence of difficulty taking medications 1-2 years prior to diagnosis (11.0% versus 2.3%), and 3-4 years prior to diagnosis (5.8% versus 2.3%). Adjusted analyses showed that compared with individuals without ADRD, those with an ADRD diagnosis had more than four times higher odds of difficulty taking medications 1-2 years prior (OR = 4.56 (CI 3.30-6.31)), and more than two times higher odds of difficulty taking medications 3-4 years prior (OR = 2.41 (CI 1.61-3.59)).
Odds of medication difficulty 1-2 years prior were more than four times greater for individuals with ADRD diagnoses compared with those without ADRD. Medication management difficulties may prompt further cognitive screening, potentially aiding in earlier recognition of ADRD.
药物管理需要复杂的认知功能，因此，服药困难可能是认知障碍的早期迹象，并且可能是阿尔茨海默病及相关痴呆症（ADRD）的一个风险因素。因此，服药困难的人可能会从更详细的认知筛查中受益，这可能有助于ADRD的诊断，而ADRD目前诊断不足。我们不清楚在美国实际ADRD诊断之前关于药物管理困难的证据。
研究服药困难与随后实际ADRD诊断之间的关联。
病例对照研究，使用与医疗保险理赔相关联的健康与退休研究（HRS）调查数据。
1993年至2012年期间共观察到1461名患有ADRD诊断的HRS受访者（病例组），按出生年份、进入HRS的波次和性别与3771名无ADRD诊断的对照组进行匹配。
我们研究了ADRD诊断与前几年（病例定义前1 - 2年和3 - 4年）自我报告的服药困难之间的关联。对照个体被分配与其匹配病例相同的索引日期。进行条件逻辑回归分析，并对年龄、性别、种族、教育程度和合并症进行调整。
与匹配的对照组相比，病例组在诊断前1 - 2年（11.0%对2.3%）和诊断前3 - 4年（5.8%对2.3%）服药困难的患病率更高。调整分析显示，与无ADRD的个体相比，患有ADRD诊断的个体在诊断前1 - 2年服药困难的几率高出四倍多（OR = 4.56（CI 3.30 - 6.31）），在诊断前3 - 4年服药困难的几率高出两倍多（OR = 2.41（CI 1.61 - 3.59））。
与无ADRD诊断的个体相比，患有ADRD诊断的个体在诊断前1 - 2年出现药物困难的几率高出四倍多。药物管理困难可能促使进一步的认知筛查，这可能有助于更早地识别ADRD。
