The association of gabapentin initiation and neurocognitive changes in older adults with normal cognition.
The association of gabapentin initiation and neurocognitive changes in older adults with normal cognition.
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DOI：
10.3389/fphar.2022.910719
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发表时间：
2022
影响因子：
5.6
通讯作者：
Abner, Erin. L. L.
中科院分区：
文献类型：
--
作者：
Oh, GYeon;Moga, Daniela. C. C.;Fardo, David. W. W.;Abner, Erin. L. L.
背景：加巴喷丁越来越多地被开给老年人，这引起了人们对其可能导致神经认知变化的担忧。因此，我们旨在研究加巴喷丁的使用与老年人神经认知变化(即认知功能下降、功能状态下降和运动功能变化)的相关性。方法：我们使用国家阿尔茨海默病协调中心统一数据集(UDS；2005年9月至2021年3月数据冻结)进行了一项回顾性队列研究。从符合条件的样本(≥年龄65岁)中，我们确定了加巴喷丁的认知正常新使用者及其发起的加巴喷丁的访问(即索引访问)。发起人根据UDS注册年份和从注册到索引的访问号码与随机选择的非用户进行匹配。认知下降被定义为临床痴呆评分(CDRGLOB)和CDR总分(CDR-SB)增加1分。功能状态下降被定义为功能活动问卷(FAQ)总和增加3分，平均FAQ增加0.3分。运动功能下降被定义为新的临床医生报告的步态紊乱、摔倒和缓慢。为了减少混淆和选择偏差，我们使用了联合稳定化的处理权重的逆概率和稳定化的权重的逆概率。所有分析都是将指数与指数+1和指数+2访问进行比较。结果：在符合条件的UDS参与者(N=23059)中，包括480名发起者(平均年龄78.7[6.9]；男性34.4%)和4320名非使用者(78.3[7.0]；34.4%)。加巴喷丁的启动与认知/功能状态下降显著相关：指数+1次就诊时CDRGLOB恶化(优势比[95%可信区间]：1.55[1.07，2.25])；指数+1次就诊时CDR-SB(1.94[1.22，3.09])；以及指数+2次就诊时的FAQ平均值(1.78[1.12，2.83])。在排除了存在运动功能障碍的启动者(n=21)后，我们确定了459名启动者(78.7[6.9]；34.0%)和4131名非使用者(78.2[6.9]；34.7%)；在该样本中，加巴喷丁的启动与指数+2就诊时跌倒增加相关(2.51[1.19，5.31])。结论：在认知功能最初正常的老年人中，加巴喷丁的启动与有害的神经认知改变显著相关。还需要进一步的研究来检验在老年人中开加巴喷丁的风险/益处。
Background: Gabapentin is increasingly prescribed to older adults, which raises concerns about its potential to cause neurocognitive changes. Therefore, we aimed to examine the association of gabapentin use with neurocognitive changes (i.e., cognitive decline, functional status decline, and motor function change) in older adults. Methods: We conducted a retrospective cohort study using the National Alzheimer’s Coordinating Center Uniform Data Set (UDS; September 2005-March 2021 data freeze). From the eligible sample (≥age 65 years), we identified cognitively normal new-users of gabapentin and the visit they initiated gabapentin (i.e., index visit). Initiators were matched to randomly selected nonusers on year of UDS enrollment and visit number from enrollment to index. Cognitive decline was defined as any increase in the Clinical Dementia Rating global score (CDRGLOB) and as a 1-point increase in CDR sum of boxes (CDR-SB). Functional status decline was defined as a 3-point increase in the sum of the Functional Activities Questionnaire (FAQ) and as 0.3-point increase in mean FAQ. Decline in motor function was defined as new clinician reports of gait disorder, falls, and slowness. To mitigate confounding and selection bias, we used joint stabilized inverse probability of treatment weights and stabilized inverse probability of censoring weights. All analyses were conducted comparing index to index+1 and index+2 visits. Results: From the eligible UDS participants (N = 23,059), we included 480 initiators (mean age [SD]: 78.7 [6.9]; male 34.4%); 4,320 nonusers (78.3 [7.0]; 34.4%). Gabapentin initiation was significantly associated with cognitive/functional status decline: worsening CDRGLOB at index+1 visit (odds ratio [95% confidence interval]: 1.55 [1.07, 2.25]); CDR-SB at index+1 visit (1.94 [1.22, 3.09]); and mean of FAQ at index+2 visit (1.78 [1.12, 2.83]). After excluding initiators with extant motor dysfunction (n = 21), we identified 459 initiators (78.7 [6.9]; 34.0%) and 4,131 nonusers (78.2 [6.9]; 34.7%); in this sample, gabapentin initiation was associated with increased falls at the index+2 visit (2.51 [1.19, 5.31]). Conclusion: Gabapentin initiation was significantly associated with deleterious neurocognitive changes among older adults with initially normal cognition. Further studies are needed to examine the risk/benefit of prescribing gabapentin in older adults.
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