COGNITIVE IMPAIRMENT AND MEDICATION APPROPRIATENESS

认知障碍是一种普遍的、致残的和代价高昂的疾病 老年人。药物使用在老年人中也很常见，包括 有认知障碍的人。两种药物之间的关系 认知功能很重要，因为药物可能会导致或 加剧认知障碍，尤其是在使用它们时 不合时宜。这项建议的长期目标是 提高社区老年人的用药适当性 个人，关注与认知风险相关的药物 损害，并通过开展药物结果研究 用药适当性的比较评估。 老年人与使用药物相关的认知损害风险 精神药物、非类固醇抗炎药(NSAIDs)或 抗惊厥药物将使用三种不同的设计进行评估： 横断面；基于预期人群的队列；以及回溯性 嵌套病例对照。需要检验的具体假设是 使用精神药物、非甾体类抗炎药或抗惊厥药物与 认知障碍。 三种不同评估方法的信度和效度 精神药物、非甾体抗炎药或抗惊厥药的用药适宜性 将会被确定。标准患者水平--药物利用回顾 (DUR)和人口水平DUR进行比较。患者级别的持续时间 也将被与利用 标准化的隐含标准，药物适宜性指数 (MAI)。需要检验的具体假设是，患者层面的 DUR将比人口水平DUR和 MAI审查将与患者水平的DUR相媲美。 这些研究利用了NIA资助的纵向公爵的数据 老年流行病学研究确定人群(EPESE) 杜克大学EPESE的一项题为《患病率中的种族差异》的子研究 和痴呆症的发病率“。 这项研究具有重要意义，因为它是第一个解决风险的研究 与使用特定的药物类别和认知有关 社区居住老年人代表性样本中的功能损害及其意义 还比较了两种评估药物适宜性的方法 人口和病人水平。这样做的最终目的是 建议加强认知受损长者的健康，方法是 提高用药适当性。

Cognitive impairment is a prevalent, disabling, and costly condition in the elderly. Medication use is also common in the elderly, including those with cognitive impairment. The relationship between medications and cognitive function is important since medications may cause or exacerbate cognitive impairment especially when they are used inappropriately. The long term objectives of this proposal are to improve medication appropriateness among community-dwelling elderly individuals, focusing on drugs associated with the risk of cognitive impairment, and to advance pharmaceutical outcome research by conducting a comparative assessment of medication appropriateness. The risk of cognitive impairment in elders associated with the use of psychotropics, nonsteroidal antiinflammatory drugs (NSAIDs) or anticonvulsants will be assessed using three different designs: cross-sectional; prospective population-based cohort; and retrospective nested case-control. The specific hypothesis to be tested is that the use of psychotropics, NSAIDs, or anticonvulsants is associated with cognitive impairment. The reliability and validity of three alternative methods of assessing medication appropriateness for psychotropics, NSAIDs or anticonvulsants will be determined. The standard patient level-drug utilization review (DUR) and a population level DUR will be compared. The patient level DUR will also be compared to an alternative approach that utilizes standardized implicit criteria, the Medication Appropriateness Index (MAI). The specific hypotheses to be tested are that the patient-level DUR will be more accurate when compared to the population level DUR and that the MAI review will be comparable to the patient level DUR. The studies capitalize on data from the NIA-funded longitudinal Duke Established Population for Epidemiological Studies of the Elderly (EPESE) and a Duke EPESE substudy entitled "Race Differences in the Prevalence and Incidence of Dementia". This study is significant because it is the first to address the risks associated with the use of specific medication classes and cognitive impairment in a representative sample of community dwelling elders and it also compares methods to assess medication appropriateness at both the population and the patient level. The ultimate objective of this proposal is to enhance the health of the cognitively impaired elderly by improving medication appropriateness.