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药物管理错误类型:与轻度认知障碍亚型的关联。

Medication management error types: Associations with mild cognitive impairment subtype.

机构信息

Department of Psychiatry and Human Behavior, Warren Alpert Medical School of Brown University, Providence, RI, USA.

Memory and Aging Program, Butler Hospital, Providence, RI, USA.

出版信息

Clin Neuropsychol. 2024 Nov;38(8):1931-1946. doi: 10.1080/13854046.2024.2339560. Epub 2024 Apr 8.

Abstract

Medication management errors are suspected to be prevalent among older adults with mild cognitive impairment (MCI). This study examined types of simulated medication-taking errors in cognitively normal older adults (CN;  = 131), single domain amnestic MCI (sdMCI,  = 91), and multi-domain MCI (mdMCI,  = 44). Errors were measured using the medication management ability assessment (MMAA). 266 participants seen for neuropsychological evaluation (94.4% White, 57.9% female, average age = 72, average education = 14 years) completed the MMAA (version 4.1), a performance-based task of medication management. Group differences in MMAA total scores, accuracy, and error types were evaluated using Kruskall-Wallis H tests. This study was the first to explore a newly operationalized error, perseverations, caused by taking a specific dose ≥2 times during the simulation. CN and sdMCI groups had higher MMAA total scores than individuals with mdMCI, indicating better overall performance. The mdMCI group made a higher number of omission errors (missed pills) than other groups, but no differences were found for commission errors (extra pills). The sdMCI group made more perseverative errors compared to the CN group. Individuals with mdMCI made more simulated medication management errors than CN and sdMCI groups, indicating that they may be most vulnerable to difficulties in medication management. In contrast, sdMCI individuals were more likely to make perseverative errors, which may reflect a tendency towards overcompensation of memory loss. Future studies should assess whether MMAA performance is associated with patterns of real-world medication-taking in more diverse samples of older adults.

摘要

药物管理错误被怀疑在轻度认知障碍(MCI)的老年人中普遍存在。本研究调查了认知正常老年人(CN;=131)、单一领域遗忘性 MCI(sdMCI,=91)和多领域 MCI(mdMCI,=44)中模拟服药错误的类型。错误使用药物管理能力评估(MMAA)进行测量。266 名接受神经心理评估的参与者(94.4%为白人,57.9%为女性,平均年龄为 72 岁,平均教育年限为 14 年)完成了 MMAA(第 4.1 版),这是一项基于表现的药物管理任务。使用 Kruskal-Wallis H 检验评估 MMAA 总分、准确性和错误类型的组间差异。本研究首次探讨了一种新的操作性错误,即由于在模拟过程中服用特定剂量≥2 次而导致的坚持错误。CN 和 sdMCI 组的 MMAA 总分高于 mdMCI 组,表明整体表现更好。mdMCI 组的遗漏错误(漏服药物)比其他组多,但未发现过量错误(多服药物)。与 CN 组相比,sdMCI 组的坚持性错误更多。与 CN 和 sdMCI 组相比,mdMCI 个体的模拟药物管理错误更多,这表明他们可能最容易出现药物管理困难。相比之下,sdMCI 个体更有可能犯坚持性错误,这可能反映了对记忆丧失的过度补偿倾向。未来的研究应该评估 MMAA 表现是否与更广泛的老年人群体的真实药物服用模式相关。

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