Association between Anticholinergic Medication Use and Risk of Dementia among Patients with Parkinson's Disease
Association between Anticholinergic Medication Use and Risk of Dementia among Patients with Parkinson's Disease
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DOI：
10.1002/phar.2305
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发表时间：
2019-07-17
期刊：
影响因子：
4.1
通讯作者：
Wu, Chung-Hsuen
中科院分区：
文献类型：
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作者：
Sheu, Jau-Jiuan;Tsai, Meng-Ting;Wu, Chung-Hsuen
研究目的评估帕金森病患者使用抗胆碱能药物(主要目标是抗胆碱能认知负担)和累积剂量(次要目标)与痴呆发病风险的关系。设计采用积极对照设计的回溯性队列研究。资料来源：台湾国民健康保险研究资料库(2001-2011)。患者共1232名成年帕金森氏症患者，他们在2002至2004年间被确诊，并在此期间至少服用了一种抗帕金森药物。在这些患者中，694人接触了被归类为轻度的抗胆碱能药物(参照组)，538人接触了被归类为中度或重度的抗胆碱能药物(暴露组)。方法和主要结果用抗胆碱能认知负荷量表(ACB)对不同类型抗胆碱能药物的暴露情况进行分类，用累积最小剂量(CMD)法计算抗胆碱能药物的累积剂量。使用多变量COX比例风险模型评估抗胆碱能药物使用与痴呆风险之间的关系。使用的抗胆碱能药物的类型(中度或重度与轻度ACB相比)与发展为痴呆症的风险增加没有显著相关性(危险比[HR]0.97，95%可信区间[CI]0.72-1.27)。在调整混杂因素后，研究发现，与低累积剂量的抗胆碱能药物相比，高累积剂量的抗胆碱能药物(>；1095累积最小剂量[CMDS])与患痴呆症的风险显著相关。
Study Objectives To evaluate the association between anticholinergic medication use, categorized by anticholinergic cognitive burden (primary objective) and cumulative dose (secondary objective), and the risk of developing dementia among patients with Parkinson's disease. Design Retrospective cohort study with an active comparator design. Data Source National Health Insurance Research Database in Taiwan (2001-2011). Patients A total of 1232 adults with Parkinson's disease who were diagnosed between 2002 and 2004 and taking at least one antiparkinson medication during this period were included. Of these patients, 694 were exposed to anticholinergic medications categorized as mild (reference group), and 538 were exposed to anticholinergic medications categorized as moderate or severe (exposure group). Measurements and Main Results Exposure to different types of anticholinergic medications was categorized by using the Anticholinergic Cognitive Burden (ACB) scale, and cumulative doses of anticholinergic medications were measured by using the cumulative minimum doses (cMD) method. Associations between anticholinergic medication use and risk of dementia were assessed by multivariable Cox proportional hazards models. The type of anticholinergics used (moderate or severe vs mild ACB) was not significantly associated with an increased risk of developing dementia (hazard ratio [HR] 0.97, 95% confidence interval [CI] 0.72-1.27). After adjusting for confounders, a high cumulative dose of anticholinergic drug (> 1095 cumulative minimum doses [cMDs]) was found to be significantly associated with an increased risk of developing dementia when compared with a low cumulative dose of anticholinergic drug (