社区居住老年人中苯二氮䓬类药物的使用与认知功能

Benzodiazepine use and cognitive function among community-dwelling elderly.

作者信息

Hanlon J T, Horner R D, Schmader K E, Fillenbaum G G, Lewis I K, Wall W E, Landerman L R, Pieper C F, Blazer D G, Cohen H J

机构信息

Department of Medicine, Duke University Medical Center, USA.

出版信息

Clin Pharmacol Ther. 1998 Dec;64(6):684-92. doi: 10.1016/S0009-9236(98)90059-5.

DOI:10.1016/S0009-9236(98)90059-5

PMID:9871433

Abstract

OBJECTIVE

To evaluate the relation between benzodiazepine use and cognitive function among community-dwelling elderly.

METHODS

This prospective cohort study included 2765 self-reporting subjects from the Duke Established Populations for Epidemiologic Studies of the Elderly. The subjects were cognitively intact at baseline (1986-1987) and alive at follow-up data collection 3 years later. Cognitive function was assessed with the Short Portable Mental Status Questionnaire (unimpaired versus impaired and change in score) and on the basis of the number of errors on the individual domains of the Orientation-Memory-Concentration Test. Benzodiazepine use was determined during in-home interviews and classified by dose, half-life, and duration. Covariates included demographic characteristics, health status, and health behaviors.

RESULTS

After control for covariates, current users of benzodiazepine made more errors on the memory test (beta coefficient, 0.35; 95% confidence interval [CI], 0.10 to 0.61) than nonusers. Further assessment of the negative effects on memory among current users suggested a dose response in which users taking the recommended or higher dose made more errors (beta coefficient, 0.57; 95% CI, 0.26 to 0.88) and a duration response in which long-term users made more errors (beta coefficient, 0.39; 95% CI, 0.05 to 0.73) than nonusers. Users of agents with long half-lives and users of agents with short half-lives both had increased memory impairment (beta coefficient, 0.32; 95% CI, 0.01 to 0.64 and beta coefficient, 0.38; 95% CI, 0.02 to 0.75, respectively) relative to nonusers. Previous benzodiazepine use was unrelated to memory problems, and current and previous benzodiazepine use was unrelated to level of cognitive functioning as measured with the other 4 tests.

CONCLUSIONS

The results suggested that current benzodiazepine use, especially in recommended or higher doses, is associated with worse memory among community-dwelling elderly.

摘要

目的

评估社区居住老年人使用苯二氮䓬类药物与认知功能之间的关系。

方法

这项前瞻性队列研究纳入了来自杜克大学老年人流行病学研究既定人群的2765名自我报告的受试者。这些受试者在基线时（1986 - 1987年）认知功能完好，且在3年后随访数据收集时仍存活。认知功能通过简短便携式精神状态问卷进行评估（未受损与受损以及得分变化），并基于定向 - 记忆 - 注意力测试各个领域的错误数量进行评估。苯二氮䓬类药物的使用情况在家庭访谈中确定，并按剂量、半衰期和使用时长进行分类。协变量包括人口统计学特征、健康状况和健康行为。

结果

在对协变量进行控制后，当前使用苯二氮䓬类药物的受试者在记忆测试中比未使用者出现更多错误（β系数，0.35；95%置信区间[CI]，0.10至0.61）。对当前使用者中记忆方面负面影响的进一步评估表明存在剂量反应，即服用推荐剂量或更高剂量的使用者出现更多错误（β系数，0.57；95% CI，0.26至0.88），以及使用时长反应，即长期使用者比未使用者出现更多错误（β系数，0.39；95% CI，0.05至0.73）。半衰期长的药物使用者和半衰期短的药物使用者相对于未使用者均出现记忆损害增加（β系数分别为0.32；95% CI，0.01至0.64和β系数，0.38；95% CI，0.02至0.75）。既往使用苯二氮䓬类药物与记忆问题无关，当前和既往使用苯二氮䓬类药物与通过其他4项测试所测量的认知功能水平无关。