Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis.
Anticholinergic drugs and incident dementia, mild cognitive impairment and cognitive decline: a meta-analysis.
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DOI：
10.1093/ageing/afaa090
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发表时间：
2020-10-23
期刊：
影响因子：
6.7
通讯作者：
Richardson K
中科院分区：
文献类型：
--
作者：
Pieper NT;Grossi CM;Chan WY;Loke YK;Savva GM;Haroulis C;Steel N;Fox C;Maidment ID;Arthur AJ;Myint PK;Smith TO;Robinson L;Matthews FE;Brayne C;Richardson K
使用具有抗胆碱能活性的药物对认知功能的长期影响尚不清楚。我们对老年人群中抗胆碱能药物与痴呆症、轻度认知功能障碍(MCI)和认知功能减退的风险之间的关系进行了系统的综述和荟萃分析。我们确定了2002年1月至2018年4月发表的研究，对强抗胆碱能药物暴露和研究结果测量之间的≥12周随访。我们汇集了调整后的优势比(OR)，用于报告痴呆症和MCI结果中任何以及至少短期(90天以上)或长期(365天以上)使用抗胆碱能药物的研究，以及认知能力下降结果的全球认知测试得分的标准化平均差异(SMD)。使用I2统计量测量统计异质性，使用Robins-I测量偏倚风险。26项研究(包括621,548名参与者)符合我们的纳入标准。任何抗胆碱能药物的使用都与痴呆事件相关(OR1.2 0，95%可信区间[CI]1.0 9-1.3 2，I2= 86%)。短期和长期服药也与偶发痴呆有关(OR1.23，95%CI1.17~1.29，I2= 2%；OR1.50，95%CI1.22~1.85，I2= 90%)。任何抗胆碱能药物的使用都与认知功能下降有关(SMD0.15；95%CI0.09~0.21，I2= 3%)，但与MCI无统计学差异(OR1.24，95%CI0.97~1.59，I2= 0%)。在观察性研究中，抗胆碱能药物的使用与痴呆症发病率增加和认知能力下降有关。然而，目前还不能推断因果联系，因为研究是观察性的，存在相当大的偏差风险。需要来自高质量研究的更有力的证据来指导长期使用的管理。
the long-term effect of the use of drugs with anticholinergic activity on cognitive function remains unclear. we conducted a systematic review and meta-analysis of the relationship between anticholinergic drugs and risk of dementia, mild cognitive impairment (MCI) and cognitive decline in the older population. We identified studies published between January 2002 and April 2018 with ≥12 weeks follow-up between strongly anticholinergic drug exposure and the study outcome measurement. We pooled adjusted odds ratios (OR) for studies reporting any, and at least short-term (90+ days) or long-term (365+ days) anticholinergic use for dementia and MCI outcomes, and standardised mean differences (SMD) in global cognition test scores for cognitive decline outcomes. Statistical heterogeneity was measured using the I2 statistic and risk of bias using ROBINS-I. twenty-six studies (including 621,548 participants) met our inclusion criteria. ‘Any’ anticholinergic use was associated with incident dementia (OR 1.20, 95% confidence interval [CI] 1.09–1.32, I2 = 86%). Short-term and long-term use were also associated with incident dementia (OR 1.23, 95% CI 1.17–1.29, I2 = 2%; and OR 1.50, 95% CI 1.22–1.85, I2 = 90%). ‘Any’ anticholinergic use was associated with cognitive decline (SMD 0.15; 95% CI 0.09–0.21, I2 = 3%) but showed no statistically significant difference for MCI (OR 1.24, 95% CI 0.97–1.59, I2 = 0%). anticholinergic drug use is associated with increased dementia incidence and cognitive decline in observational studies. However, a causal link cannot yet be inferred, as studies were observational with considerable risk of bias. Stronger evidence from high-quality studies is needed to guide the management of long-term use.
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影响因子：
6.3
作者：
Kashyap M;Belleville S;Mulsant BH;Hilmer SN;Paquette A;Tu le M;Tannenbaum C
通讯作者：
Tannenbaum C
影响因子：
4.1
作者：
Sheu, Jau-Jiuan;Tsai, Meng-Ting;Wu, Chung-Hsuen
通讯作者：
Wu, Chung-Hsuen
影响因子：
4.2
作者：
Papenberg, Goran;Backman, Lars;Johnell, Kristina
通讯作者：
Johnell, Kristina
影响因子：
4.1
作者：
Grossi, Carlota M.;Richardson, Kathryn;Savva, George M.
通讯作者：
Savva, George M.
影响因子：
3.3
作者：
Wu, Yi-Hui;Wang, Chih-Jen;Chen, Liang-Kung
通讯作者：
Chen, Liang-Kung