Potentially Inappropriate Medication, Anticholinergic Burden, and Mortality in People Attending Memory Clinics
Potentially Inappropriate Medication, Anticholinergic Burden, and Mortality in People Attending Memory Clinics
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DOI：
10.3233/jad-170265
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发表时间：
2017-01-01
影响因子：
4
通讯作者：
Elliott, Rohan A.
中科院分区：
文献类型：
--
作者：
Cross, Amanda J.;George, Johnson;Elliott, Rohan A.
背景资料：关于潜在不适当药物（PIM）和老年认知障碍患者死亡率之间的关联的证据有限。目的：研究是否使用被认为是潜在不适当的老年认知障碍患者药物（PIMcog）和抗胆碱能认知负担（ACB）与参加记忆诊所的患者的死亡率相关。对MEMORY诊所前瞻性研究（PRIME）研究数据的横截面和纵向分析。参与者是居住在社区的人，他们参加了9个记忆诊所，并被诊断为轻度认知障碍或痴呆症。PIMcog被定义为根据Beers或STOPP标准被认为可能不适合认知障碍患者的任何药物。使用ACB量表计算抗胆碱能负荷。时间依赖性Cox比例风险回归用于分析3年随访期间PIMcog使用/ACB评分与全因死亡率之间的相关性。回归模型包括基线变量：年龄，性别，教育，认知诊断，药物，疾病负担，认知，身体功能，和神经精神symptoms.Results的总数：964名参与者中，360（37.3%）使用一个或多个PIMcog在研究期间的某个时间，最常见的抗胆碱能药物和镇静剂。624名（64.7%）参与者在研究期间的某个时间点使用了具有潜在或明确抗胆碱能特性（ACB>0）的药物。PIMcog的使用（调整后的危险比：1.42 95%CI：1.12-1.80）和ACB评分（调整后的危险比：1.18 95%CI：1.06-1.32）均与死亡率相关。
Background: There is limited evidence regarding the association between potentially inappropriate medications (PIM) and mortality in older people with cognitive impairment.Objective: To examine whether use of medications considered to be potentially inappropriate in older people with cognitive impairment (PIMcog) and anticholinergic cognitive burden (ACB) were associated with mortality in people who attended memory clinics.Methods: Cross-sectional and longitudinal analyses of data from the Prospective Research In MEmory clinics (PRIME) study. Participants were community-dwelling people who attended nine memory clinics and had a diagnosis of mild cognitive impairment or dementia. PIMcog was defined as any medication considered potentially inappropriate for a person with cognitive impairment according to Beers or STOPP criteria. Anticholinergic burden was calculated using the ACB scale. Time-dependent Cox-proportional hazards regression was used to analyze associations between PIMcog use/ACB score and all-cause mortality over a three-year follow-up period. The regression model included the baseline variables: age, gender, education, cognitive diagnoses, total number of medications, disease-burden, cognition, physical function, and neuropsychiatric symptoms.Results: Of 964 participants, 360 (37.3%) used one or more PIMcog at some time during the study; most commonly anticholinergics and sedatives. 624 (64.7%) participants used a medication with potential or definite anticholinergic properties (ACB>0) at some point during the study. Both PIMcog use (adjusted hazard ratio: 1.42 95% CI: 1.12-1.80) and ACB score (adjusted hazard ratio: 1.18 95% CI: 1.06-1.32) were associated with mortality.Conclusion: Use of PIMcogs and medications with anticholinergic properties was common among memory clinic patients and both were associated with mortality.