Anticholinergic drug burden according to the anticholinergic drug scale and the German anticholinergic burden and their impact on cognitive function in multimorbid elderly German people: a multicentre observational study.
Anticholinergic drug burden according to the anticholinergic drug scale and the German anticholinergic burden and their impact on cognitive function in multimorbid elderly German people: a multicentre observational study.
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根据抗胆碱能药物量表的抗胆碱能药物负担和德国抗胆碱能负担及其对多病德国老年人认知功能的影响：一项多中心观察研究
DOI：
10.1136/bmjopen-2020-044230
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发表时间：
2021-03-23
期刊：
影响因子：
2.9
通讯作者：
Scherer M
中科院分区：
文献类型：
--
作者：
Krüger C;Schäfer I;van den Bussche H;Bickel H;Fuchs A;Gensichen J;König HH;Maier W;Mergenthal K;Riedel-Heller SG;Schön G;Weyerer S;Wiese B;von Renteln-Kruse W;Langebrake C;Scherer M
本研究的目的是检查MultiCare队列中多病老年患者的抗胆碱能药物使用情况，并评估抗胆碱能负担与认知功能之间的关系。MultiCare作为一项纵向队列研究，在德国8个不同的研究中心进行了初级保健研究，共有3189名患者（59.3%为女性）。基线数据用于以下分析。根据已建立的抗胆碱能药物量表（ADS）和最近出版的德国抗胆碱能负荷（German anti - cholinergic burden， ACB）对药物进行分类。采用字母数字替代测试（LDST）测量认知功能，并采用混合效应多元线性回归计算抗胆碱能负荷对认知功能的影响。患者根据ADS使用了1764种抗胆碱能药物，根据German ACB评分使用了2750种抗胆碱能药物，患病率分别为38.4%和53.7%。平均ADS评分为0.8（±1.3）分，平均German ACB评分为1.2（±1.6）分。最常见的ADS抗胆碱能药物是速尿（5.8%），最常见的ACB抗胆碱能药物是二甲双胍（13.7%）。大多数鉴定出的抗胆碱能药物是低抗胆碱能潜能的药物，分别为80.2% （ADS）和73.4% （ACB）。根据LDST，增加的ADS和German ACB评分与认知功能下降相关（分别为- 0.26;p=0.008和- 0.24;p=0.003）。根据ADS和German ACB评分，多病老年患者使用抗胆碱能药物的风险较高。我们尤其需要对心血管系统中具有低抗胆碱能潜能的药物的作用有更大的认识。由于抗胆碱能药物的使用与多病老年患者认知功能下降有关，合理开具处方和减少处方的重要性有待进一步评估。ISRCTN89818205。
The aims of our study were to examine the anticholinergic drug use and to assess the association between anticholinergic burden and cognitive function in the multimorbid elderly patients of the MultiCare cohort. MultiCare was conducted as a longitudinal cohort study in primary care, located in eight different study centres in Germany. 3189 patients (59.3% female). Baseline data were used for the following analyses. Drugs were classified according to the well-established anticholinergic drug scale (ADS) and the recently published German anticholinergic burden (German ACB). Cognitive function was measured using a letter digit substitution test (LDST) and a mixed-effect multivariate linear regression was performed to calculate the influence of anticholinergic burden on the cognitive function. Patients used 1764 anticholinergic drugs according to ADS and 2750 anticholinergics according to the German ACB score (prevalence 38.4% and 53.7%, respectively). The mean ADS score was 0.8 (±1.3), and the mean German ACB score was 1.2 (±1.6) per patient. The most common ADS anticholinergic was furosemide (5.8%) and the most common ACB anticholinergic was metformin (13.7%). The majority of the identified anticholinergics were drugs with low anticholinergic potential: 80.2% (ADS) and 73.4% (ACB), respectively. An increasing ADS and German ACB score was associated with reduced cognitive function according to the LDST (−0.26; p=0.008 and −0.24; p=0.003, respectively). Multimorbid elderly patients are in a high risk for using anticholinergic drugs according to ADS and German ACB score. We especially need to gain greater awareness for the contribution of drugs with low anticholinergic potential from the cardiovascular system. As anticholinergic drug use is associated with reduced cognitive function in multimorbid elderly patients, the importance of rational prescribing and also deprescribing needs to be further evaluated. ISRCTN89818205.
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