Talukdar Imdadul Haque, Thant Poe Eindra, Saha Sanjib
Department of Learning, Informatics, Management, and Ethics (LIME), Karolinska Institute, Solna, Sweden.
Health Economics Unit, Department of Clinical Science (Malmö), Lund University, Lund, Sweden.
Aging Ment Health. 2025 May;29(5):767-778. doi: 10.1080/13607863.2024.2436501. Epub 2024 Dec 9.
The aim of this systematic review and meta-analysis was to analyse and summarize studies on the effects of polypharmacy on people living with dementia (PwD). The study aimed to categorize these effects, evaluate the quality of the studies, and estimate the pooled effect sizes of these consequences using meta-analysis.
A systematic literature review was conducted following the PRISMA guideline. Covidence software was used for screening, study selection, and data extraction. The quality assessment was conducted using the Newcastle-Ottawa Scale (NOS) scale. Random effect models were used to perform the meta-analyses and the heterogeneity was reported with I statistics.
This review of 19 studies found that polypharmacy is significantly associated with potentially inappropriate medication (PIM), hospitalisation, adverse drug reactions, and mortality. The quality of the studies was fair to good. Meta-analysis revealed that the odds of having PIM among the PwD exposed to polypharmacy was 2.93 times (95% CI: 2.24-3.82; I = 95.6%). The studies showed heterogeneity in design, sample size, follow-up duration, confounder adjustment, polypharmacy definitions, and inconsistent tools for dementia diagnosis.
Polypharmacy in PwD is associated with increased potentially inappropriate medication, adverse drug reactions, and hospitalisation. Regular management of polypharmacy is recommended in clinical practice.
本系统评价和荟萃分析旨在分析和总结关于多重用药对痴呆症患者影响的研究。该研究旨在对这些影响进行分类，评估研究质量，并使用荟萃分析估计这些后果的合并效应量。
按照PRISMA指南进行系统文献综述。使用Covidence软件进行筛选、研究选择和数据提取。使用纽卡斯尔-渥太华量表（NOS）进行质量评估。采用随机效应模型进行荟萃分析，并使用I统计量报告异质性。
对19项研究的综述发现，多重用药与潜在不适当用药（PIM）、住院、药物不良反应和死亡率显著相关。研究质量为中等至良好。荟萃分析显示，暴露于多重用药的痴呆症患者发生PIM的几率为2.93倍（95%置信区间：2.24-3.82；I=95.6%）。这些研究在设计、样本量、随访时间、混杂因素调整、多重用药定义以及痴呆症诊断工具不一致等方面存在异质性。
痴呆症患者的多重用药与潜在不适当用药、药物不良反应和住院率增加有关。临床实践中建议对多重用药进行定期管理。
