Daniela C. Moga, 241 Lee T. Todd Jr. Building, 789 S. Limestone, Lexington, KY 40536, 859-323-9682,
J Prev Alzheimers Dis. 2022;9(4):646-654. doi: 10.14283/jpad.2022.55.
Cognitive reserve has been hypothesized as a mechanism to explain differences in individual risk for symptomatic expression of Alzheimer's Disease (AD). Inappropriate medications may diminish cognitive reserve, precipitating the transition from preclinical AD (pAD) to a symptomatic state. To date, there is limited data on the potential impact of medication optimization as a potential tool for slowing the symptomatic expression of AD.
(1) To test the efficacy of a medication therapy management intervention designed to bolster cognitive reserve in community-dwelling older adults without dementia. (2) To evaluate the efficacy of intervention by baseline pAD status.
A 1-year randomized controlled trial was conducted in community-dwelling older adults without dementia. Randomization was stratified by amyloid β positron emission tomography levels.
Community-based, Lexington, Kentucky.
Adults 65 years or older with no evidence of dementia and reporting at least one potentially inappropriate medication as listed in the Beers 2015 criteria were recruited. The study aimed to enroll 90 participants based on the a priori sample size calculation.
Medication therapy management versus standard of care.
Primary outcomes were: (1) one-year changes in the Medication Appropriateness Index; (2) one-year changes in Trail Making Test B under scopolamine challenge.
The medication therapy management intervention resulted in significant improvement in Medication Appropriateness Index scores. Overall, there was no beneficial effect of the medication therapy management on Trail Making Test B scores, however stratified analysis demonstrated improvement in Trail Making Test B challenged scores associated with the medication therapy management for those with elevated amyloid β positron emission tomography levels consistent with pAD.
Medication therapy management can reduce inappropriate medication use in older adults at risk for AD. Our study indicated beneficial cognitive effects in those with preclinical Alzheimer's Disease. No statistically significant effects were evident in the study group as a whole, or in those without preclinical cerebral amyloidosis. Further work designed to improve the effectiveness of the medication therapy management approach and defining other preclinical pathologic states that may benefit from medication optimization are readily achievable goals for promoting improved cognitive health and potentially delaying the onset of symptomatic AD.
认知储备被假设为一种解释阿尔茨海默病（AD）症状表现个体风险差异的机制。不适当的药物治疗可能会降低认知储备，促使从临床前 AD（pAD）向症状状态过渡。迄今为止，关于药物优化作为减缓 AD 症状表现的潜在工具的潜在影响的数据有限。
（1）测试旨在增强无痴呆社区居住老年人认知储备的药物治疗管理干预的疗效。（2）评估干预对基线 pAD 状态的疗效。
在无痴呆的社区居住老年人中进行了为期 1 年的随机对照试验。随机分组按淀粉样蛋白 β 正电子发射断层扫描水平分层。
基于社区的肯塔基州列克星敦。
招募年龄在 65 岁或以上、无痴呆证据且报告至少一种符合 Beers 2015 标准的潜在不适当药物的成年人。该研究旨在根据预先计算的样本量招募 90 名参与者。
药物治疗管理与标准护理。
主要结果是：（1）药物适宜性指数的一年变化；（2）在东莨菪碱挑战下的连线测试 B 的一年变化。
药物治疗管理干预导致药物适宜性指数评分显著改善。总体而言，药物治疗管理对连线测试 B 评分没有有益影响，但分层分析表明，对于那些淀粉样蛋白 β 正电子发射断层扫描水平升高与 pAD 一致的人，与药物治疗管理相关的连线测试 B 受挑战分数有所改善。
药物治疗管理可以减少 AD 高危老年人中不适当的药物使用。我们的研究表明，在临床前阿尔茨海默病患者中认知有有益的影响。在整个研究组或在没有临床前脑淀粉样蛋白病的患者中，没有观察到统计学上显著的效果。进一步设计旨在提高药物治疗管理方法的有效性并确定可能受益于药物优化的其他临床前病理状态，是促进认知健康和潜在延迟症状性 AD 发作的易于实现的目标。
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