Ziad Abdelkrim, Berr Claudine, Ruiz Fabrice, Bégaud Bernard, Lemogne Cédric, Goldberg Marcel, Zins Marie, Mura Thibault
ClinSearch-110, Avenue Pierre Brossolette, Malakoff, France.
Population-based Epidemiological Cohorts Unit, US 011 Inserm, Villejuif, France.
Drug Saf. 2021 May;44(5):565-579. doi: 10.1007/s40264-021-01043-5. Epub 2021 Feb 11.
Psychotropic drugs such as anxiolytics, antidepressants and antipsychotics may have anticholinergic properties that could directly affect patients' cognition.
Our objective was to assess the relationship between exposure to anticholinergic-positive (AC+) psychotropic drugs and cognitive impairment compared with psychotropic drugs without anticholinergic activity (AC-).
This analysis included participants (aged 45-70 years) enrolled between January 2012 and October 2017 in the CONSTANCES cohort treated with psychotropic drugs (antidepressants n = 2602, anxiolytics n = 1195, antipsychotics n = 197) in the 3 years preceding cognitive assessment. Within each drug class, the Anticholinergic Cognitive Burden scale was used to classify drugs as either AC+ or AC-. Cognitive impairment was defined as a score below - 1 standard deviation from the standardized mean of the neuropsychological score. We used multiple logistic regression models and matching on propensity score to estimate the relationship between anticholinergic activity and cognitive impairment.
Our analyses did not show any increased risk of cognitive impairment for AC+ antidepressants and anxiolytics, with the exception of a slight increase for AC+ antidepressants in episodic memory (odds ratio [OR] 1.19; 95% confidence interval [CI] 1.05-1.36). Conversely, we found a more marked increase in risk with AC+ antipsychotics on executive function (Trail Making Test-A [TMT-A], OR 4.49 [95% CI 2.59-7.97] and TMT-B, OR 3.62 [95% CI 2.25-5.89]).
Our results suggest there is no clinically relevant association between the anticholinergic activity of antidepressant and anxiolytic drugs and cognitive impairment in middle-aged adults. An association could exist between AC+ antipsychotics and executive function.
抗焦虑药、抗抑郁药和抗精神病药等精神药物可能具有抗胆碱能特性，这可能直接影响患者的认知。
我们的目的是评估与无抗胆碱能活性（AC-）的精神药物相比，接触抗胆碱能阳性（AC+）精神药物与认知障碍之间的关系。
该分析纳入了2012年1月至2017年10月期间在CONSTANCES队列中登记的参与者（年龄45-70岁），这些参与者在认知评估前3年接受了精神药物治疗（抗抑郁药n = 2602，抗焦虑药n = 1195，抗精神病药n = 197）。在每个药物类别中，使用抗胆碱能认知负担量表将药物分类为AC+或AC-。认知障碍定义为得分低于神经心理评分标准化均值的-1个标准差。我们使用多元逻辑回归模型并根据倾向得分进行匹配，以估计抗胆碱能活性与认知障碍之间的关系。
我们的分析未显示AC+抗抑郁药和抗焦虑药导致认知障碍的风险有任何增加，但AC+抗抑郁药在情景记忆方面有轻微增加（优势比[OR] 1.19；95%置信区间[CI] 1.05-1.36）。相反，我们发现AC+抗精神病药对执行功能的风险增加更为明显（连线测验A [TMT-A]，OR 4.49 [95% CI 2.59-7.97]和TMT-B，OR 3.62 [95% CI 2.25-5.89]）。
我们的结果表明，抗抑郁药和抗焦虑药的抗胆碱能活性与中年成年人的认知障碍之间不存在临床相关关联。AC+抗精神病药与执行功能之间可能存在关联。
