Medication Profiles of Patients with Cognitive Impairment and High Anticholinergic Burden.
Medication Profiles of Patients with Cognitive Impairment and High Anticholinergic Burden.
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DOI：
10.1007/s40266-018-0522-x
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发表时间：
2018-03
期刊：
影响因子：
2.8
通讯作者：
Bayliss EA
中科院分区：
文献类型：
--
作者：
Green AR;Reifler LM;Boyd CM;Weffald LA;Bayliss EA
具有抗胆碱能特性的药物被认为可能不适合认知障碍患者，因为伤害-包括精神错乱、摔倒和骨折-可能会超过好处。为了突出改善认知障碍和多种慢性病患者的临床决策和护理的机会，我们确定了轻度认知障碍(MCI)和痴呆患者的不同亚组，他们具有较高的累积抗胆碱能负担和特定的抗胆碱能使用模式。非营利性综合交付系统中的回溯性队列研究。参与者包括65岁及以上社区居住的成年人(N=13,627)，他们患有MCI或痴呆症，并至少患有其他两种慢性病。我们从药房和电子健康记录(EHR)数据中计算每个参与者的抗胆碱能认知负担(ACB)分数。在平均12个月ACB评分≥为2的个体中，我们使用凝聚层次聚类来识别具有相似抗胆碱能处方模式的个体的组或群。3,257人(24%)有较高的抗胆碱能负荷，定义为ACB评分≥2。基于锚定药物或药物类别的临床有意义的集群包括：一组心血管药物(n=1497；46%)；两组抗抑郁药物(n=633；20%)；以及一组基于膀胱抗肌肉瘤药物的集群(n=431；13%)。几个簇由多种中枢神经系统活性药物组成。心血管和中枢神经系统活性药物在认知障碍和多种慢性病患者的抗胆碱能负担中占相当大的比例。抗抑郁药非常普遍。通过这些抗胆碱能药物簇阐明的临床特征可以为治疗提供有针对性的方法。
Drugs with anticholinergic properties are considered potentially inappropriate in patients with cognitive impairment because harms – including delirium, falls and fractures – may outweigh benefits. To highlight opportunities to improve clinical decision making and care for patients with cognitive impairment and multiple chronic conditions, we identified distinct subgroups of patients with mild cognitive impairment (MCI) and dementia who had high cumulative anticholinergic burden and specific patterns of anticholinergic use. Retrospective cohort study in a not-for-profit, integrated delivery system. Participants included community-dwelling adults aged 65 and older (N=13,627) with MCI or dementia and at least 2 other chronic diseases. We calculated the Anticholinergic Cognitive Burden (ACB) score for each participant from pharmacy and electronic health record (EHR) data. Among individuals with a mean 12 month ACB score ≥2, we used agglomerative hierarchical clustering to identify groups, or clusters, of individuals with similar anticholinergic prescription patterns. 3,257 (24%;) had high anticholinergic burden, defined as an ACB score ≥2. Clinically meaningful clusters based upon anchoring medications or drug classes included: a cluster of cardiovascular medications (n = 1497; 46%); two clusters of antidepressant medications (n = 633; 20%); and a cluster based on use of bladder antimuscarinics (n = 431; 13%). Several clusters were comprised of multiple central nervous system-active drugs. Cardiovascular and central nervous system-active medications comprise a substantial portion of anticholinergic burden in people with cognitive impairment and multiple chronic conditions. Antidepressants were highly prevalent. Clinical profiles elucidated by these clusters of anticholinergic medications can inform targeted approaches to care.
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