Cognitive burden of anticholinergic medications in psychotic disorders.
Cognitive burden of anticholinergic medications in psychotic disorders.
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DOI：
10.1016/j.schres.2017.03.034
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发表时间：
2017-12
影响因子：
4.5
通讯作者：
Bishop JR
中科院分区：
文献类型：
--
作者：
Eum S;Hill SK;Rubin LH;Carnahan RM;Reilly JL;Ivleva EI;Keedy SK;Tamminga CA;Pearlson GD;Clementz BA;Gershon ES;Keshavan MS;Keefe RSE;Sweeney JA;Bishop JR
患有精神障碍的患者通常用许多药物治疗，其中许多具有抗胆碱能活性。我们评估了与双极-精神分裂症中间表型网络（B-SNIP）研究参与者治疗方案中包含的多种药物的累积抗胆碱能负荷相关的认知。临床稳定的参与者与精神分裂症（n=206），情感障碍（n=131），精神病性双相情感障碍（n=146）进行了检查。使用抗胆碱能药物量表（ADS）对所有预定药物的抗胆碱能特性进行定量。将各个药物的ADS评分相加，以创建每个参与者的ADS总负担评分，并与精神分裂症认知简要评估（BACS）相关。在精神分裂症患者中，所有药物的抗胆碱能负荷与ADS评分为4时开始的认知表现呈负相关。与ADS<4的患者相比，ADS评分≥4的患者的复合BACS评分较低（p=0.004）。在BACS分测验中，言语记忆受高抗胆碱能负荷的不利影响最大。尽管各组抗胆碱能负荷评分相似，但在情感性或精神病性双相情感障碍中未检测到抗胆碱能负荷的显著影响。我们确定了抗胆碱能负荷对临床稳定的精神分裂症患者认知功能的不良影响阈值。这种关系在情感性精神病中没有发现。对其他药物、剂量和临床指标的检查不能解释这些结果。精神分裂症患者对抗胆碱能药物的认知易感性可能增加，并且在临床实践中考虑药物治疗方案的总体效应可能很重要。
Patients with psychotic disorders are often treated with numerous medications, many of which have anticholinergic activity. We assessed cognition in relation to the cumulative anticholinergic burden of multiple drugs included in treatment regimens of participants from the Bipolar-Schizophrenia Network on Intermediate Phenotypes (B-SNIP) study. Clinically stable participants with schizophrenia (n=206), schizoaffective disorder (n=131), and psychotic bipolar disorder (n=146) were examined. Anticholinergic properties of all scheduled drugs were quantified using the Anticholinergic Drug Scale (ADS). ADS scores were summed across individual drugs to create a total ADS burden score for each participant and examined in relation to the Brief Assessment of Cognition in Schizophrenia (BACS). Anticholinergic burden aggregated across all medications was inversely related to cognitive performance starting at ADS scores of 4 in participants with schizophrenia. Those with ADS scores ≥4 had lower composite BACS scores compared to those with ADS<4 (p=0.004). Among BACS subtests, Verbal Memory was the most adversely affected by high anticholinergic burden. Despite similar anticholinergic burden scores across groups, a significant effect of anticholinergic burden was not detected in schizoaffective or psychotic bipolar disorder. We identified an adverse effect threshold of anticholinergic burden on cognition in clinically stable participants with schizophrenia. This relationship was not identified in affective psychoses. Examination of other medications, doses, and clinical measures did not account for these findings. Patients with schizophrenia may have increased cognitive susceptibility to anticholinergic medications and the aggregate effects of one’s medication regimen may be important to consider in clinical practice.
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作者：
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DOI：
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