Associations Between Polypharmacy and Cognitive and Physical Capability: A British Birth Cohort Study
Associations Between Polypharmacy and Cognitive and Physical Capability: A British Birth Cohort Study
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DOI：
10.1111/jgs.15317
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发表时间：
2018-05-01
影响因子：
6.3
通讯作者：
Richards, Marcus
中科院分区：
文献类型：
--
作者：
Rawle, Mark James;Cooper, Rachel;Richards, Marcus
目的：研究多种药物治疗与认知和身体能力之间的纵向关联，并确定这些关联是否与多种药物治疗的累积暴露不同。设计：前瞻性出生队列研究。地点：英格兰、苏格兰和威尔士。参与者：来自医学研究理事会全国健康与发展调查的男性和女性的合格样本，具有69岁时的药物数据（N = 2，122，79%）。测量：认知能力使用单词学习测试、视觉搜索速度任务和Addenbrooke认知检查，第三版（ACE-III）来评估。身体能力进行了测量，椅子上升速度，站立平衡时间，步行速度，和gripstrength.RESULTS：多药（5-8处方药）是目前在18.2%的参与者在69岁和过度多药（9处方药）在4.7%。在调整了性别、教育和疾病负担的模型中，两者都与认知和身体能力较差有关。发现过度的多种药物治疗（例如，比较多种用药的平均ACE-III评分差异=-2.0，95% CI = -2.8至-1.1，过度多种用药=-2.9，95% CI = -4.4至-1.4，无多种用药）。在60岁至64岁和69岁的多药参与者中，认知和身体能力的负相关性更强，在60岁至64岁和69岁的多药参与者中，（例如，平均椅子上升速度的差异，比较两个年龄段的多种药物治疗与非多种药物治疗=-3.9，95%CI = -5.2 ~-2.6，60-64岁仅为-2.5，95%CI = -4.1 ~-0.9）。结论：60 - 64岁和69岁的多药治疗与较差的身体和认知能力相关，即使调整了疾病负担。在长期服用多种药物的参与者中观察到更强的负相关性，这表明了累积的剂量依赖关系（剂量是处方药物的数量）。未来旨在改善认知和身体能力的研究应考虑采取干预措施，减少年轻人多药治疗的持续时间和水平，以及通过适当的药物优化疾病控制。
OBJECTIVES: To investigate longitudinal associations between polypharmacy and cognitive and physical capability and to determine whether these associations differ with cumulative exposure to polypharmacy.DESIGN: Prospective birth cohort study.SETTING: England, Scotland, and Wales.PARTICIPANTS: An eligible sample of men and women from the Medical Research Council National Survey of Health and Development with medication data at age 69 (N = 2,122, 79%).MEASUREMENTS: Cognitive capability was assessed using a word learning test, visual search speed task, and the Addenbrooke's Cognitive Examination, Third Edition (ACE-III). Physical capability was measured using chair rise speed, standing balance time, walking speed, and grip strength.RESULTS: Polypharmacy (5-8 prescribed medications) was present in 18.2% of participants at age 69 and excessive polypharmacy (9 prescribed medications) in 4.7%. Both were associated with poorer cognitive and physical capability in models adjusted for sex, education, and disease burden. Stronger associations were found for excessive polypharmacy (e.g., difference in mean ACE-III scores comparing polypharmacy = -2.0, 95% CI = -2.8 to -1.1 and excessive polypharmacy = -2.9, 95% CI = -4.4 to -1.4 with no polypharmacy). Participants with polypharmacy at age 60 to 64 and at age 69 showed stronger Negative associations with cognitive and physical capability were stronger still in participants with polypharmacy at both age 60 to 64 and at age 69 (e.g. difference in mean chair rise speed, comparing polypharmacy with no polypharmacy at both ages = -3.9, 95% CI = -5.2 to -2.6 and at age 60-64 only = -2.5, 95% CI = -4.1 to -0.9).CONCLUSION: Polypharmacy at age 60 to 64 and age 69 was associated with poorer physical and cognitive capability, even after adjusting for disease burden. Stronger negative associations were seen in participants with longstanding polypharmacy, suggesting a cumulative, dose-dependent relationship (where dose is the number of prescribed medications). Future research aiming to improve cognitive and physical capability should consider interventions to reduce the duration and level of polypharmacy at younger ages, in addition to optimizing disease control with appropriate medications.