Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia; Faculty of Health Sciences, University of Stavanger, Stavanger, Norway.
Centre for Age-Related Medicine (SESAM), Stavanger University Hospital, Stavanger, Norway; Semillero de Neurociencias y Envejecimiento, Ageing Institute, Medical School, Pontificia Universidad Javeriana. Bogotá, Colombia.
Arch Gerontol Geriatr. 2021 Sep-Oct;96:104459. doi: 10.1016/j.archger.2021.104459. Epub 2021 Jun 24.
In dementia, a number of factors may influence functional decline in addition to cognition. In this study, we aimed to study the potential association of the number of prescribed medications with functional decline trajectories over a five-year follow-up in people diagnosed with mild Alzheimer's disease (AD) or Lewy Body dementia (LBD).
This is a longitudinal analysis of a Norwegian cohort study entitled "The Dementia Study of Western Norway". We included 196 patients newly diagnosed with AD (n=111) and LBD (n=85), followed annually for 5 years. We conducted linear mixed-effects models to analyse the association of the number of medications with functional decline measured by the Rapid Disability Rating Scale - 2.
The mean prescribed medications at baseline was 4.18∓2.60, for AD 3.92∓2.51 and LBD 4.52∓2.70. The number of medications increased during the follow-up; at year five the mean for AD was 7.28∓4.42 and for LBD 8.11∓5.16. Using more medications was associated with faster functional decline in AD (Est 0.04, SE 0.01, p-value 0.003) and LBD (Est 0.08, SE 0.03, p-value 0.008) after adjusting for age, sex, comorbidity, neuropsychiatric symptoms, and cognition. For each medication added during the follow-up, functional trajectories worsened by 1% for AD and 2% for LBD. The number of medications was not associated with cognitive decline.
We found that higher number of medications was related to a faster functional decline, both in AD and LBD. With disease progression, there was an increase in the number of medications. Prescription in dementia should be carefully assessed, possibly improving the functional prognosis.
在痴呆症中，除认知能力外，还有许多因素可能会影响功能下降。在这项研究中，我们旨在研究在五年随访期间，诊断为轻度阿尔茨海默病（AD）或路易体痴呆（LBD）的患者中，处方药物数量与功能下降轨迹之间的潜在关联。
这是对挪威一项名为“西部挪威痴呆症研究”的队列研究的纵向分析。我们纳入了 196 名新诊断为 AD（n=111）和 LBD（n=85）的患者，每年随访 5 年。我们使用线性混合效应模型分析了快速残疾评定量表-2 测量的功能下降与药物数量之间的关系。
基线时的平均处方药物数为 4.18±2.60，AD 为 3.92±2.51，LBD 为 4.52±2.70。在随访期间，药物数量增加；AD 组的药物数量在第五年时平均为 7.28±4.42，LBD 组为 8.11±5.16。调整年龄、性别、合并症、神经精神症状和认知功能后，使用更多药物与 AD（估计值 0.04，SE 0.01，p 值<0.003）和 LBD（估计值 0.08，SE 0.03，p 值<0.008）的功能下降速度加快有关。在随访期间每增加一种药物，AD 和 LBD 的功能轨迹分别恶化 1%和 2%。药物数量与认知能力下降无关。
我们发现，药物数量的增加与 AD 和 LBD 患者的功能下降速度加快有关。随着疾病的进展，药物数量增加。痴呆症的处方应仔细评估，可能会改善功能预后。
