HRB Centre for Primary Care Research, Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland.
The Irish Longitudinal Study on Ageing, Trinity College Dublin, Dublin, Ireland.
Br J Clin Pharmacol. 2021 Jul;87(7):2818-2829. doi: 10.1111/bcp.14687. Epub 2020 Dec 18.
To estimate the association between patterns of anticholinergic, benzodiazepine and Z-drug medication use and change in cognitive function in middle-aged and older adults.
This prospective cohort study used data from the first three waves of The Irish Longitudinal Study on Ageing (TILDA), including community-dwelling adults aged ≥50 years followed for up to 4 years (n = 7027). Cognitive function was assessed using the Mini Mental State Examination, animal naming test and word recall tests. Regular medication use was self-reported at baseline and follow-up interviews at 2 and 4 years. Pharmacy dispensing claims for a subset (n = 2905) allowed assessment of medication use between interviews and cumulative dosage. Medication use at consecutive waves of TILDA was analysed in relation to change in cognitive function between waves.
Strongly anticholinergic medications (Anticholinergic Cognitive Burden scale 3), benzodiazepines and Z-drugs were reported by 7.3%, 5.8% and 5.1% of participants, respectively, at any time during the study. Adjusting for potential confounders, new anticholinergic use between interviews was associated with change in recall score (-1.09, 95% confidence interval -1.64, -0.53) over 2 years compared to non-use, but not with MMSE (0.07; 95% CI -0.21, 0.34) or animal naming (-0.70; 95% CI -1.43, 0.03). The pharmacy claims analysis was consistent with this finding. Other hypothesised associations were not supported.
Except for new use of anticholinergic medications, no other findings supported a risk of cognitive decline over 2-year periods in this middle-aged and older cohort. Patients and prescribers should weigh this potential risk against potential benefits of commencing anticholinergic medications.
评估中老年人抗胆碱能药物、苯二氮䓬类药物和 Z 类药物用药模式与认知功能变化之间的关联。
本前瞻性队列研究使用爱尔兰老龄化纵向研究（TILDA）的前三个波次的数据，包括年龄≥50 岁的社区居住成年人，随访时间长达 4 年（n=7027）。认知功能使用简易精神状态检查、动物命名测试和单词回忆测试进行评估。基线和随访 2 年和 4 年时通过自我报告评估常规用药情况。对一部分（n=2905）进行药物配药记录，以评估两次访谈之间的用药情况和累计剂量。分析 TILDA 连续波次的药物使用情况与波次之间认知功能变化的关系。
在研究期间的任何时候，分别有 7.3%、5.8%和 5.1%的参与者报告使用过强抗胆碱能药物（抗胆碱能认知负担量表 3）、苯二氮䓬类药物和 Z 类药物。在调整潜在混杂因素后，与非使用者相比，访谈期间新使用抗胆碱能药物与 2 年内的回忆评分变化相关（-1.09，95%置信区间-1.64，-0.53），但与 MMSE（0.07；95%置信区间-0.21，0.34）或动物命名（-0.70；95%置信区间-1.43，0.03）无关。药物配药记录分析结果与该发现一致。其他假设的关联没有得到支持。
除了新使用抗胆碱能药物外，在这个中年和老年队列中，没有其他发现支持 2 年内认知能力下降的风险。患者和处方医生应权衡开始使用抗胆碱能药物的潜在风险与潜在获益。
