The anticholinergic effect on cognition (AEC) scale-Associations with mortality, hospitalisation and cognitive decline following dementia diagnosis
The anticholinergic effect on cognition (AEC) scale-Associations with mortality, hospitalisation and cognitive decline following dementia diagnosis
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DOI：
10.1002/gps.5330
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发表时间：
2020-05-20
影响因子：
4
通讯作者：
Mueller, Christoph
中科院分区：
文献类型：
--
作者：
Bishara, Delia;Perera, Gayan;Mueller, Christoph
目的探讨中枢抗胆碱能负荷（确定通过抗胆碱能效应认知[AEC]规模）和死亡率，住院治疗和认知功能下降的患者与dementia.Methods的南伦敦和莫兹利NHS基金会信托（SLaM）临床记录交互式搜索（CRIS）的应用程序之间的关联，以确定患者的首次诊断为痴呆症。通过自然语言处理算法提取药物暴露，允许计算和比较AEC评分。数据被链接到国家死亡率和住院数据源，并连续记录的简易精神状态检查（MMSE）分数被用来调查cognitive decline.Results认知能力下降，我们确定了14 093例痴呆症患者，60.7%是女性，平均年龄诊断为79.8岁。需要对其药物进行审查的患者（任何单个药物的AEC评分>= 2或总AEC评分>= 3）死亡风险增加（风险比1.07; 95%置信区间[CI]：1.01-1.15）和急诊住院（1.10; 95% CI：1.04-1.17），但与住院时间无关。认知轨迹分析表明，这暴露组有较低的MMSE评分在诊断和一个急剧增加的MMSE评分在随后的6个月，但类似的斜率为6至36个月期间相比，其余的sample.Conclusions痴呆患者接受药物治疗具有高中枢抗胆碱能活性似乎有更差的预后死亡率和住院风险，但有，主要是急性认知功能受损，而不是认知能力下降的长期差异。
Objectives To investigate associations between central anticholinergic burden (determined through the anticholinergic effect on cognition [AEC] scale) and mortality, hospitalisation and cognitive decline in patients with dementia.Methods The South London and Maudsley NHS Foundation Trust (SLaM) Clinical Records Interactive Search (CRIS) application was used to identify patients with a first diagnosis of dementia. Medication exposure was extracted through a natural language processing algorithm, allowing for calculations and comparisons of AEC scores. Data were linked to national mortality and hospitalisation data sources, and serially recorded Mini-Mental State Examination (MMSE) scores were used to investigate cognitive decline.Results We identified 14 093 patients with dementia, 60.7% were female and the mean age at diagnosis was 79.8 years. Patients for whom a review of their medication was indicated (AEC score >= 2 for any individual drug or total AEC score >= 3) had an increased risk of mortality (hazard ratio 1.07; 95% confidence interval [CI]: 1.01-1.15) and emergency hospitalisation (1.10; 95% CI: 1.04-1.17), but there were no associations with duration of hospitalisation. Cognitive trajectory analyses showed that this exposure group had lower MMSE scores at diagnosis and a sharper increase in MMSE scores over the subsequent 6 months, but similar slopes for the 6 to 36 months period compared to the remainder of the sample.Conclusions Patients with dementia receiving medication with high central anticholinergic activity appear to have worse prognosis in terms of mortality and hospitalisation risk, but have, primarily, acutely impaired cognitive function, rather than longer-term differences in cognitive decline.