Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study
Use of drugs with anticholinergic effect and impact on cognition in Parkinson's disease: a cohort study
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DOI：
10.1136/jnnp.2009.186239
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发表时间：
2010-02-01
影响因子：
11
通讯作者：
Aarsland, Dag
中科院分区：
文献类型：
--
作者：
Ehrt, Uwe;Broich, Karl;Aarsland, Dag
背景认知功能下降在帕金森病（PD）中很常见。虽然一些病因学因素是已知的，但尚不清楚是否具有抗胆碱能活性（AA）的药物有助于这种认知能力下降。这些知识将提供机会，以防止加速认知功能下降的PD.Objective研究是否使用抗胆碱能药物的性质是一个独立的危险因素，认知功能下降的PD患者patients.Methods一个以社区为基础的队列PD患者（n=235），并在基线进行评估。他们在4年和8年后重新评估。认知功能采用简易精神状态检查（MMSE）进行评估。对所有处方药物的AA进行了详细评估，并根据标准化量表对AA进行了分类。认知功能下降和AA负荷和治疗持续时间之间的关系进行了评估，使用双变量和多变量statistical analysis.Results超过40%的使用药物与AA在基线。在8年的随访中，与未服用此类药物的患者（中位下降1分; p=0.025）相比，服用AA药物的患者（MMSE中位下降6.5分）的认知能力下降更高。在线性回归分析调整年龄，基线认知和抑郁症，显着协会与MMSE下降被发现为总AA负荷（标准化β =0.229，p=0.04），以及使用AA药物的持续时间（标准化β 0.231，p=0.032）。结论我们的研究结果表明，有抗胆碱能药物的使用和认知能力下降PD之间的关联。这可能为临床医生提供了一个重要的机会，通过避免使用AA药物来避免增加认知功能下降的进展。临床医生需要提高对具有抗胆碱能特性的药物类别的认识。
Background Cognitive decline is common in Parkinson's disease (PD). Although some of the aetiological factors are known, it is not yet known whether drugs with anticholinergic activity (AA) contribute to this cognitive decline. Such knowledge would provide opportunities to prevent acceleration of cognitive decline in PD.Objective To study whether the use of agents with anticholinergic properties is an independent risk factor for cognitive decline in patients with PD.Methods A community-based cohort of patients with PD (n=235) were included and assessed at baseline. They were reassessed 4 and 8 years later. Cognition was assessed using the Mini-Mental State Examination (MMSE). A detailed assessment of the AA of all drugs prescribed was made, and AA was classified according to a standardised scale. Relationships between cognitive decline and AA load and duration of treatment were assessed using bivariate and multivariate statistical analyses.Results More than 40% used drugs with AA at baseline. During the 8-year follow-up, the cognitive decline was higher in those who had been taking AA drugs (median decline on MMSE 6.5 points) compared with those who had not taken such drugs (median decline 1 point; p=0.025). In linear regression analyses adjusting for age, baseline cognition and depression, significant associations with decline on MMSE were found for total AA load (standardised beta=0.229, p=0.04) as well as the duration of using AA drugs (standardised beta 0.231, p=0.032).Conclusion Our findings suggest that there is an association between anticholinergic drug use and cognitive decline in PD. This may provide an important opportunity for clinicians to avoid increasing progression of cognitive decline by avoiding drugs with AA. Increased awareness by clinicians is required about the classes of drugs that have anticholinergic properties.