Anticholinergic drugs and functional, cognitive impairment and behavioral disturbances in patients from a memory clinic with subjective cognitive decline or neurocognitive disorders
Anticholinergic drugs and functional, cognitive impairment and behavioral disturbances in patients from a memory clinic with subjective cognitive decline or neurocognitive disorders
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DOI：
10.1186/s13195-017-0284-4
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发表时间：
2017-08-01
影响因子：
9
通讯作者：
Krolak-Salmon, Pierre
中科院分区：
文献类型：
--
作者：
Dauphinot, Virginie;Mouchoux, Christelle;Krolak-Salmon, Pierre
背景：具有抗胆碱能特性的药物可能与多种临床不良反应有关。方法：2012-01/2014-06在一家记忆诊所对主观性认知减退(SCD)或神经性认知障碍(NCD)的门诊患者进行横断面研究。用抗胆碱能药物量表(ADS)、抗胆碱能危险量表(ARS)、抗胆碱能认知负荷(ACB)、Chew‘s评分、han’s评分和AC活性药物个数测定AC负荷。采用日常生活能力量表(IADL)、简易精神状态检查量表(MMSE)和神经精神病学问卷(NPI)评定患者的功能、认知功能和行为障碍。结果：473例患者中，46.3%为主要非传染性疾病患者。患者平均服用5.3+/-2.6种药物。韩氏评分越高(p=0.001)，使用AC药物的次数越多，MMSE越低。无论交流测量结果如何，交流负荷越高，IADL越低。ACB、韩氏评分、AC用药次数越多，NPI越高。调整后，所有AC评分仍与IADL相关，而韩氏评分和AC用药次数仍与MMSE相关。结论：在SCD和NCD患者中，AC负荷与较低的功能评分有关，而AC负荷与认知表现或行为障碍之间的横断面关联因AC评分的不同而异。在处方具有AC特性的药物时应特别注意，特别是在有记忆主诉的患者中。
Background: Drugs with anticholinergic properties may be associated with various adverse clinical effects. The relationship between the anticholinergic (AC) burden and functional, global cognitive performance and behavior disturbances was assessed among elderly patients.Methods: A cross-sectional study was conducted between January 2012 and June 2014 in a memory clinic among outpatients living at home and with subjective cognitive decline (SCD) or neurocognitive disorders (NCD). The AC burden was measured using the Anticholinergic Drug Scale (ADS), the Anticholinergic Risk Scale (ARS), the Anticholinergic Cognitive Burden (ACB), Chew's score, Han's score, and the number of drugs with AC activity. Functional, cognitive performance and behavior disturbances were assessed using the Instrumental Activities of Daily Living (IADL) scale (IADL), the Mini Mental State Examination (MMSE), and the Neuropsychiatric Inventory (NPI).Results: Among 473 included patients, 46.3% were at major NCD. Patients took on average 5.3 +/- 2.6 drugs. MMSE was lower when Han's score (p = 0.04) and number of AC drugs were higher (p < 0.001). IADL was lower when AC burden was higher, whatever the AC measurement. NPI was higher when ACB, Han's score, and number of AC drugs were higher. After adjustment, all AC scores remained associated with IADL, while Han's score and number of drugs with AC remained associated with the MMSE.Conclusions: In patients with SCD or NCD, AC burden is associated with lower functional score, whereas the cross-sectional association between AC burden and cognitive performance or behavioral disturbance varies according to AC scores. Particular attention should be paid when prescribing drugs with AC properties, especially among patients with memory complaints.