Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients
Use of medications with anticholinergic effect predicts clinical severity of delirium symptoms in older medical inpatients
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DOI：
10.1001/archinte.161.8.1099
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发表时间：
2001-04-23
影响因子：
--
通讯作者：
Élie, M
中科院分区：
文献类型：
--
作者：
Han, L;McCusker, J;Élie, M
背景：使用抗胆碱能（ACH）药物是谵妄的生物学上合理和潜在的可改变的危险因素，但研究结果在其与谵妄的关系方面存在矛盾。目的：评估乙酰胆碱类药物的使用与谵妄症状严重程度之间的纵向关联，并确定这种关联是否因痴呆的存在而改变。患者和方法：对278例65岁及以上诊断为偶发性或常发性谵妄的住院患者进行随访，并使用谵妄指数进行反复评估，随访时间长达3周。每天测量乙酰胆碱和其他药物的暴露量。使用混合线性回归模型评估谵妄指数评估前24小时药物暴露变化之间的关系。结果：在随访期间（平均+/- SD， 12.3 +/-7.0天），人群中使用了47种可能对乙酰胆碱过敏的药物（平均1.4种药物/患者/天）。谵妄严重程度的增加与前一天乙酰胆碱药物暴露的几项测量显着相关，调整痴呆、基线谵妄严重程度、随访时间和服用非agh药物的数量。痴呆并没有改变乙酰胆碱药物使用与谵妄严重程度之间的关系。结论：暴露于乙酰胆碱类药物与诊断为谵妄的老年住院患者谵妄症状严重程度的随后增加独立且特异性相关。
Background: Use of anticholinergic (ACH) medications is a biologically plausible and potentially modifiable risk factor of delirium, but research findings are conflicting regarding its association with delirium.Objectives: To evaluate the longitudinal association between use of ACH medications and severity of delirium symptoms and to determine whether this association is modified by the presence of dementia.Patients and Methods: A total of 278 medical inpatients 65 years and older with diagnosed incident or prevalent delirium were followed up with repeated assessments using the Delirium Index for up to 3 weeks. Exposure to ACH and other medications was measured daily. The association between change in medication exposure in the 24 hours preceding a Delirium Index assessment was assessed using a mixed linear regression model.Results: During follow-up (mean +/- SD, 12.3 +/-7.0 days), 47 medications with potential ACH effect were used in the population (mean, 1.4 medications per patient per day). Increase in delirium severity was significantly associated with several measures of ACH medication exposure on the previous day, adjusting for dementia, baseline delirium severity, length of follow-up, and number of non-AGH medications taken. Dementia did not modify the association between ACH medication use and delirium severity.Conclusion: Exposure to ACH medications is independently and specifically associated with a subsequent increase in delirium symptom severity in elderly medical inpatients with diagnosed delirium.