Anticholinergic Medication Burden-Associated Cognitive Impairment in Schizophrenia.
Anticholinergic Medication Burden-Associated Cognitive Impairment in Schizophrenia.
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DOI：
10.1176/appi.ajp.2020.20081212
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发表时间：
2021-09-01
期刊：
影响因子：
--
通讯作者：
Light GA
中科院分区：
文献类型：
--
作者：
Joshi YB;Thomas ML;Braff DL;Green MF;Gur RC;Gur RE;Nuechterlein KH;Stone WS;Greenwood TA;Lazzeroni LC;MacDonald LR;Molina JL;Nungaray JA;Radant AD;Silverman JM;Sprock J;Sugar CA;Tsuang DW;Tsuang MT;Turetsky BI;Swerdlow NR;Light GA
许多用于治疗精神分裂症的精神药物具有显著的抗胆碱能特性，这与健康受试者的认知障碍和痴呆风险有关。阐明抗胆碱能药物负荷对认知功能损害的影响可能有助于优化精神分裂症的认知结局。本研究的目的是全面描述这种负担如何影响精神分裂症门诊患者多个认知领域的功能。横断面数据进行了分析，使用推理统计和探索性结构方程模型，以确定抗胆碱能药物负荷和认知之间的关系。被诊断为精神分裂症或情感性精神障碍的患者（N = 1，120）是从美国五所大学的社区招募的，作为精神分裂症遗传学联盟的一部分。对于每名参与者，根据改良的抗胆碱能认知负担（ACB）量表对处方药物进行评级和汇总。认知功能通过宾夕法尼亚大学计算机神经认知成套测验（PCNB）各领域的表现进行评估。ACB评分与认知表现显著相关，在PCNB测试的所有领域，ACB评分较高的组比ACB评分较低的组差。在其他认知测试中也观察到类似的影响。在控制了人口统计学特征和疾病严重程度的潜在代理（包括临床症状和氯丙嗪等效抗精神病药物剂量）后，效果仍然显着。精神分裂症的抗胆碱能药物负担是大量的，常见的，由多个药物类别赋予，并与所有认知领域的认知障碍相关。所有药物类别的抗胆碱能药物负担-包括常规护理中使用的精神药物-应在治疗决策中考虑，并在精神分裂症认知功能研究中考虑。
Many psychotropic medications used to treat schizophrenia have significant anticholinergic properties, which are linked to cognitive impairment and dementia risk in healthy subjects. Clarifying the impact of cognitive impairment attributable to anticholinergic medication burden may help optimize cognitive outcomes in schizophrenia. The aim of this study was to comprehensively characterize how this burden affects functioning across multiple cognitive domains in schizophrenia outpatients. Cross-sectional data were analyzed using inferential statistics and exploratory structural equation modeling to determine the relationship between anticholinergic medication burden and cognition. Patients with a diagnosis of schizophrenia or schizoaffective disorder (N = 1,120) were recruited from the community at five U.S. universities as part of the Consortium on the Genetics of Schizophrenia–2. For each participant, prescribed medications were rated and summed according to a modified Anticholinergic Cognitive Burden (ACB) scale. Cognitive functioning was assessed by performance on domains of the Penn Computerized Neurocognitive Battery (PCNB). ACB score was significantly associated with cognitive performance, with higher ACB groups scoring worse than lower ACB groups on all domains tested on the PCNB. Similar effects were seen on other cognitive tests. Effects remained significant after controlling for demographic characteristics and potential proxies of illness severity, including clinical symptoms and chlorpromazine-equivalent antipsychotic dosage. Anticholinergic medication burden in schizophrenia is substantial, common, conferred by multiple medication classes, and associated with cognitive impairments across all cognitive domains. Anticholinergic medication burden from all medication classes—including psychotropics used in usual care—should be considered in treatment decisions and accounted for in studies of cognitive functioning in schizophrenia.
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影响因子：
4.5
作者：
Eum S;Hill SK;Rubin LH;Carnahan RM;Reilly JL;Ivleva EI;Keedy SK;Tamminga CA;Pearlson GD;Clementz BA;Gershon ES;Keshavan MS;Keefe RSE;Sweeney JA;Bishop JR
通讯作者：
Bishop JR
影响因子：
3.4
作者：
HALL, RCW
通讯作者：
HALL, RCW
影响因子：
4.5
作者：
Joshi, Yash B.;Thomas, Michael L.;Light, Gregory A.
通讯作者：
Light, Gregory A.
DOI：
10.1016/j.jalz.2012.02.005
发表时间：
2013-07
期刊：
Alzheimer's & dementia : the journal of the Alzheimer's Association
影响因子：
--
作者：
Cai X;Campbell N;Khan B;Callahan C;Boustani M
通讯作者：
Boustani M
影响因子：
4.2
作者：
Desmarais, Julie Eve;Beauclair, Linda;Margolese, Howard C.
通讯作者：
Margolese, Howard C.