Moellmann Henriette Louise, Boulghoudan Soufian, Kuhlmann Julian, Rahm Louisa, Frohnhofen Helmut
Cranio-and-Maxillo Facial Surgery, University Hospital Düsseldorf, Moorenstraße 5, 40225, Düsseldorf, Germany.
Heinrich-Heine-Universität Düsseldorf, Universitätsstraße 1, 40225, Düsseldorf, Germany.
Z Gerontol Geriatr. 2025 May;58(3):203-208. doi: 10.1007/s00391-024-02388-z. Epub 2025 Jan 6.
Polypharmacy is a widespread phenomenon in older patients. In particular, the anticholinergic burden of medication is an important risk factor for delirium due to age-related changes in the cholinergic system.
Preoperative medication, including the calculation of the anticholinergic burden (ACB), was recorded in a prospective study (421 patients) to identify potential risks associated with medication intake. Postoperative delirium screening was carried out daily.
The study included 199 women (47.3%) and 222 men (52.7%) aged 80.8 ± 6.7 years and 78.8 ± 6.2 years, respectively. Antidepressants odds ratio (OR) 3.16 (95% confidence interval. CI, 1.51-6.64), antidiabetic drugs OR 2.53 (95% CI 1.27-5.03), neuroleptics OR 3.52 (95% CI 1.70-7.28) and Parkinson medication OR 5.88 (95% CI 1.95-17.7) showed a significantly higher risk for delirium. The ACB score revealed an anticholinergic burden in 43 patients (10.4%). The delirium rate was 25.6% (n = 11) and 11.0% (n = 40) had no anticholinergic burden. A significant correlation can be demonstrated with χ(1) = 7.52, p = 0.006, Cramer's V = 0.136. There was a 2.79-fold higher risk of delirium (OR 2.79, 95% CI 1.31-5.97).
The standardized recording of medication is essential, especially when identifying patients at risk of suffering from delirium. The use of the ACB score to assess the anticholinergic burden is a simple and reliable screening tool and should be part of a preoperative geriatric assessment.
多重用药在老年患者中是一种普遍现象。特别是，由于胆碱能系统的年龄相关变化，药物的抗胆碱能负担是谵妄的一个重要危险因素。
在一项前瞻性研究（421例患者）中记录术前用药情况，包括抗胆碱能负担（ACB）的计算，以确定与用药相关的潜在风险。每天进行术后谵妄筛查。
该研究纳入了199名女性（47.3%）和222名男性（52.7%），年龄分别为80.8±6.7岁和78.8±6.2岁。抗抑郁药的比值比（OR）为3.16（95%置信区间CI，1.51 - 6.64），抗糖尿病药物的OR为2.53（95%CI 1.27 - 5.03），抗精神病药的OR为3.52（95%CI 1.70 - 7.28），帕金森病药物的OR为5.88（95%CI 1.95 - 17.7），显示谵妄风险显著更高。ACB评分显示43例患者（10.4%）存在抗胆碱能负担。谵妄发生率为25.6%（n = 11），无抗胆碱能负担的患者为11.0%（n = 40）。χ(1)=7.52，p = 0.006，克莱默V = 0.136，显示有显著相关性。发生谵妄的风险高2.79倍（OR 2.79，95%CI 1.31 - 5.97）。
规范记录用药情况至关重要，尤其是在识别有谵妄风险的患者时。使用ACB评分评估抗胆碱能负担是一种简单可靠的筛查工具，应成为术前老年评估的一部分。
