Sondh Harsharon Kaur, Bishara Delia, Perera Gayan, Shetty Hitesh, Stewart Robert, Mueller Christoph
Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London SE5 8AB, UK.
South London and Maudsley NHS Foundation Trust, London SE5 8AZ, UK.
Age Ageing. 2025 May 31;54(6). doi: 10.1093/ageing/afaf154.
Comorbidities and polypharmacy are common in people with dementia, leading to a higher risk of adverse outcomes. While the impact of anticholinergic properties has been extensively investigated, less is known about other cross-category properties of medications.
To investigate whether medications with dizziness or hypotension as a side effect are associated with adverse outcomes in older adults with dementia.
Retrospective cohort study.
From a South London catchment, 15 210 patients diagnosed with dementia between 2008 and 2017.
Medications with dizziness and/or hypotension listed as a side effect were compiled and quantified in the cohort. Multivariable Cox regression models were run to determine the risk of mortality, all-cause emergency hospitalisation and hospitalisation due to falls. Generalised estimating equations were applied to investigate cognitive decline. The final model adjusted for 19 potential confounders, including physical and mental health measures.
Of the patients, 82.2% were receiving at least one dizziness-associated medication and 71.2% at least one hypotension-associated medication. For each additional medication associated with dizziness or hypotension, there was a 4% increased risk of all-cause emergency hospitalisation. No associations were found with hospitalised falls specifically or with mortality or cognitive decline.
Medications that potentially cause dizziness or hypotension were associated with an increased risk of hospitalisation, although not specifically hospitalisation caused by falls. More systematic attention should be paid to coprescribing around the time of dementia diagnosis and the potential for rationalising this to minimise adverse drug events.
共病和多重用药在痴呆症患者中很常见，会导致更高的不良后果风险。虽然抗胆碱能特性的影响已得到广泛研究，但对于药物的其他跨类别特性了解较少。
调查有头晕或低血压副作用的药物是否与老年痴呆症患者的不良后果相关。
回顾性队列研究。
从伦敦南部地区，选取了2008年至2017年间确诊为痴呆症的15210名患者。
汇总并量化队列中列出有头晕和/或低血压副作用的药物。运行多变量Cox回归模型以确定死亡率、全因急诊住院和跌倒导致的住院风险。应用广义估计方程研究认知能力下降情况。最终模型对19个潜在混杂因素进行了调整，包括身心健康指标。
在这些患者中，82.2%的人正在服用至少一种与头晕相关的药物，71.2%的人正在服用至少一种与低血压相关的药物。每增加一种与头晕或低血压相关的药物，全因急诊住院风险就会增加4%。未发现与特定的跌倒住院、死亡率或认知能力下降存在关联。
可能导致头晕或低血压的药物与住院风险增加有关，尽管并非 specifically 由跌倒导致的住院。在痴呆症诊断时，应更加系统地关注联合用药情况，并有可能对其进行合理化调整，以尽量减少药物不良事件。
