Association Between Prescribing of Anticholinergic Medications and Incident Delirium: A Cohort Study
Association Between Prescribing of Anticholinergic Medications and Incident Delirium: A Cohort Study
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DOI：
10.1111/j.1532-5415.2011.03676.x
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发表时间：
2011-11-01
影响因子：
6.3
通讯作者：
Boustani, Malaz
中科院分区：
文献类型：
--
作者：
Campbell, Noll;Perkins, Anthony;Boustani, Malaz
目的：描述抗胆碱能药物与住院老年认知功能障碍患者的谵妄事件之间的关系，并检验抗胆碱能药物会增加谵妄事件风险的假设。设计：观察性队列研究。地点：印第安纳州印第安纳波利斯的城市公立医院。参与者：147名年龄在65岁及以上的认知障碍参与者，在进入普通内科病房时谵妄筛查为阴性。在入院时的认知功能进行了评估，使用简短的便携式精神状态问卷（SPMSQ）。评估了从入院到最终谵妄评估之间的抗胆碱能药物治疗顺序。使用抗胆碱能认知负担量表确定抗胆碱能药物医嘱。谵妄进行了评估，使用混乱的评估方法。结果：百分之五十七的队列收到至少一个订单可能的抗胆碱能药物，28%收到至少一个订单明确的抗胆碱能药物。谵妄的发生率为整个队列的22%。在调整年龄、性别、种族、基线SPMSQ评分和Charlson Comorrhage指数后，可能接受抗胆碱能药物治疗的患者发生谵妄的比值比（OR）为0.33（95%置信区间（CI）= 0.10-1.03）。有明确抗胆碱能药物医嘱者发生谵妄的OR为0.43（95%CI = 0.11-1.63）。结论：本研究结果不支持抗胆碱能药物处方会增加住院老年认知功能障碍患者发生谵妄的风险这一假设。这种关系需要建立使用前瞻性研究设计与药物分配数据，以提高谵妄的预测模型的性能。J Am Geriatr Soc 59：S277-S281，2011.
OBJECTIVES: To describe the association between anticholinergic medications and incident delirium in hospitalized older adults with cognitive impairment and to test the hypothesis that anticholinergic medications would increase the risk of incident delirium.DESIGN: Observational cohort study.SETTING: Urban public hospital in Indianapolis, Indiana.PARTICIPANTS: One hundred forty-seven participants aged 65 and older with cognitive impairment who screened negative for delirium at the time of admission to a general medical ward.MEASUREMENTS: Cognitive function at the time of admission was assessed using the Short Portable Mental Status Questionnaire (SPMSQ). Anticholinergic medication orders between the time of admission and the final delirium assessment were evaluated. Anticholinergic medication orders were identified using the Anticholinergic Cognitive Burden Scale. Delirium was assessed using the Confusion Assessment Method.RESULTS: Fifty-seven percent of the cohort received at least one order for possible anticholinergic medications, and 28% received at least one order for definite anticholinergic medications. The incident rate for delirium was 22% of the entire cohort. After adjusting for age, sex, race, baseline SPMSQ score, and Charlson Comorbidity Index, the odds ratio (OR) for developing delirium in those with orders for possible anticholinergic medications was 0.33 (95% confidence interval (CI) = 0.10-1.03). The OR for developing delirium among those with orders for definite anticholinergic medications was 0.43 (95% CI = 0.11-1.63).CONCLUSION: The results did not support the hypothesis that prescription of anticholinergic medications increases the risk of incident delirium in hospitalized older adults with cognitive impairment. This relationship needs to be established using prospective study designs with medication dispensing data to improve the performance of predictive models of delirium. J Am Geriatr Soc 59:S277-S281, 2011.