Ageing Clinical & Experimental Research (ACER) Team, Institute of Applied Health Sciences, University of Aberdeen, Aberdeen, UK; Faculty of Health and Medical Sciences, University of Copenhagen, Denmark.
Department of Medicine for the Elderly, Addenbrooke's Hospital, Cambridge, UK; Cambridge Institute of Public Health, University of Cambridge, Cambridge, UK; Department of Medicine, University of Cambridge, Cambridge, UK.
Maturitas. 2020 Dec;142:55-63. doi: 10.1016/j.maturitas.2020.07.006. Epub 2020 Jul 25.
To examine whether anticholinergic medication exposure in middle and late life is associated with physical capability.
We used data from 8477 men and women who had enrolled in the European Prospective Investigation of Cancer-Norfolk study at baseline (1HC; 1993-1997) and who had attended its third health examination (3HC; 2004-2010). Medication history at the 1HC and 3HC was used to score participants according to the Anticholinergic Cognitive Burden (ACB) Scale at baseline and 3HC; participants were categorised as ACB = 0, ACB = 1, ACB>2.
At 3HC, physical capability was objectively measured by: usual walking speed, maximum grip strength, timed chair stands speed (TCSS) and standing balance. Linear and logistic regression models examined prospective and cross-sectional associations between ACB and physical capability, controlling for co-morbidity, sociodemographic and lifestyle factors.
The analyses included 3386 men and 4110 women who were 56.4 (SD 7.9) and 55.0 (7.7) years old respectively at baseline and 69.4 (8.1) and 67.9 (8.0) years old at follow-up. Significant cross-sectional and prospective relationships were observed for all physical capability measures in women, except grip strength. For example, women with ACB ≥ 2 compared with ACB = 0 at baseline had 0.07 m/s (95 % CI -0.11, -0.03) slower usual walking speed, 2.61 stands/min (-4.17, -1.05) slower TCSS and higher odds of being unable to complete a tandem stand (odds ratio 2.40, 95 % CI 1.53, 3.76). These trends were observed in men but were less consistent in prospective analyses.
Exposure to anticholinergic medication predicts poor physical capability and is a potentially reversible risk factor.
研究中老年时期抗胆碱能药物的暴露与身体机能的关系。
我们使用了参加欧洲癌症前瞻性调查-诺福克研究的 8477 名男性和女性的数据，这些人在基线时（1HC；1993-1997 年）参加了研究，并在第三次健康检查时（3HC；2004-2010 年）参加了研究。根据基线和 3HC 的抗胆碱能认知负担（ACB）量表，使用参与者在 1HC 和 3HC 时的用药史对其进行评分；参与者被分为 ACB=0、ACB=1、ACB>2。
在 3HC 时，身体机能通过以下指标进行客观测量：常速步行速度、最大握力、坐站速度（TCSS）和站立平衡。线性和逻辑回归模型分别考察了 ACB 与身体机能的前瞻性和横断面关联，同时控制了合并症、社会人口统计学和生活方式因素。
分析包括 3386 名男性和 4110 名女性，他们在基线时的年龄分别为 56.4（标准差 7.9）岁和 55.0（标准差 7.7）岁，随访时的年龄分别为 69.4（标准差 8.1）岁和 67.9（标准差 8.0）岁。在女性中，除握力外，所有身体机能测量指标均存在显著的横断面和前瞻性关联。例如，与基线时 ACB=0 的女性相比，ACB≥2 的女性常速步行速度慢 0.07m/s（95%置信区间-0.11，-0.03），TCSS 速度慢 2.61 次/min（-4.17，-1.05），并且无法完成串联站立的可能性更高（比值比 2.40，95%置信区间 1.53，3.76）。这些趋势在男性中也有观察到，但前瞻性分析的一致性较低。
抗胆碱能药物的暴露预测身体机能较差，是一个潜在可逆转的危险因素。
