Methodological challenges in determining longitudinal associations between anticholinergic drug use and incident cognitive decline.
Methodological challenges in determining longitudinal associations between anticholinergic drug use and incident cognitive decline.
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DOI：
10.1111/jgs.12632
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发表时间：
2014-02
影响因子：
6.3
通讯作者：
Tannenbaum C
中科院分区：
文献类型：
--
作者：
Kashyap M;Belleville S;Mulsant BH;Hilmer SN;Paquette A;Tu le M;Tannenbaum C
比较纵向研究中使用不同抗胆碱能药物量表和不同认知能力下降模型的效果。纵向队列研究。加拿大魁北克省门诊部。 60 岁及以上且没有痴呆或抑郁症的人 (n = 102)。使用基线和 1 年随访数据，应用四种抗胆碱能负担指标（药物负担指数的抗胆碱能成分 (DBI-Ach)、抗胆碱能认知负担 (ACB)、抗胆碱能药物量表 (ADS) 和抗胆碱能风险量表 (ARS)）。将三种认知下降模型（原始神经心理学测试分数恶化、可靠变化指数（RCI）和基于标准化回归的测量（SRB））与《精神疾病诊断和统计手册》第五版（DSM-V）中新的轻度神经认知障碍的发病标准进行比较。使用逻辑回归检查关联的一致性。识别出 1 年内抗胆碱能负担增加的个体的频率从使用 DBI-Ach 的 18% 到使用 ACB 的 23% 不等。使用不同模型识别认知能力下降的频率范围为 8% 至 86%。相对于 DSM-V 标准，原始变化评分具有最高的敏感性 (0.91)，RCI 的特异性最高 (0.93)。使用 SRB 方法的记忆力下降与 ACB（比值比 (OR) = 5.3，95% 置信区间 (CI) = 1.1–25.8）、ADS（OR = 5.7，95% CI = 1.1–27.7）和 ARS（OR = 6.5，95% CI = 1.34–32.3）的增加相关。 DBI-Ach 的增加与使用原始变化评分方法进行的记忆测试（OR = 4.2，95% CI = 1.8–15.4）和使用 SRB 的越野测试 B 部分（OR = 2.9，95% CI = 1.1–8.0）的下降相关。使用 DSM-V 标准或 RCI 方法未观察到关联。选择不同的方法来定义药物暴露和认知能力下降将对药物流行病学研究的结果产生重大影响。
To compare the effect of using different anticholinergic drug scales and different models of cognitive decline in longitudinal studies. Longitudinal cohort study. Outpatient clinics, Quebec, Canada. Individuals aged 60 and older without dementia or depression (n = 102). Using baseline and 1-year follow-up data, four measures of anticholinergic burden (anticholinergic component of the Drug Burden Index (DBI-Ach), Anticholinergic Cognitive Burden (ACB), Anticholinergic Drug Scale (ADS), and Anticholinergic Risk Scale (ARS)) were applied. Three models of cognitive decline (worsening of raw neuropsychological test scores, Reliable Change Index (RCI), and a standardized regression based measure (SRB)) were compared in relation to Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria for the onset of a new mild neurocognitive disorder. The consistency of associations was examined using logistic regression. The frequency of identifying individuals with an increase in anticholinergic burden over 1 year varied from 18% with the DBI-Ach to 23% with the ACB. The frequency of identifying cognitive decline ranged from 8% to 86% using different models. The raw change score had the highest sensitivity (0.91), and the RCI the highest specificity (0.93) against DSM-V criteria. Memory decline using the SRB method was associated with an increase in ACB (odds ratio (OR) = 5.3, 95% confidence interval (CI) = 1.1–25.8), ADS (OR = 5.7, 95% CI = 1.1–27.7), and ARS (OR = 6.5, 95% CI = 1.34–32.3). An increase in the DBI-Ach was associated with a decline on memory testing using the raw change score method (OR = 4.2, 95% CI = 1.8–15.4) and on the Trail-Making Test Part B using SRB (OR = 2.9, 95% CI = 1.1–8.0). No associations were observed using the DSM-V criteria or RCI method. The choice of different methods for defining drug exposure and cognitive decline will have a significant effect on the results of pharmacoepidemiological studies.
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影响因子：
7
作者：
Montorio, I;Izal, M
通讯作者：
Izal, M
影响因子：
2.4
作者：
Sawrie, SM
通讯作者：
Sawrie, SM
影响因子：
6.7
作者：
DESROSIERS, J;BRAVO, G;DUBUC, N
通讯作者：
DUBUC, N
DOI：
10.1124/jpet.102.041616
发表时间：
2003-09-01
影响因子：
3.5
作者：
Terry, AV;Buccafusco, JJ
通讯作者：
Buccafusco, JJ
影响因子：
4.8
作者：
Nebes, RD;Pollock, BG;Reynolds, CF
通讯作者：
Reynolds, CF