Impact of cumulative exposure to anticholinergic and sedative drugs on cognition in older adults: a memory clinic cohort study.

IF 7.9 1区 医学 Q1 CLINICAL NEUROLOGY
Elsa Reallon, Frédéric Gervais, Claire Moutet, Virginie Dauphinot, Pauline Desnavailles, Teddy Novais, Pierre Krolak-Salmon, Antoine Garnier-Crussard, Christelle Mouchoux
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引用次数: 0

Abstract

Background: Long-term exposure to anticholinergic and sedative drugs could be a modifiable risk factor for cognitive decline. The objective of this study was to measure the association between previous cumulative anticholinergic and sedative drug exposure (Drug Burden Index) and cognitive decline.

Methods: A cohort study (MEMORA cohort) was conducted in a French memory clinic for patients attending a consultation between November 2014 and December 2020, with at least 2 Mini-Mental State Examination (MMSE) measurements (≥ 6 months apart) and available medication data from the local Primary Health Insurance Fund database (n = 1,970). Drug Burden Index was linearly cumulated until each MMSE measurement and was used to categorise patients according to their level of exposure (no exposure, moderate, or high). The longitudinal association between Drug Burden Index and MMSE was assessed using a multivariate linear mixed model, adjusted for age, education level, anxiety disorders, depressive disorders, functional autonomy, and behavioural disorders.

Results: Overall, 1,970 patients were included with a mean follow-up duration of 2.78 years (± 1.54) and 2.99 visits per patients (5,900 MMSE + Drug Burden Index measurements collected). At baseline, 68.0% of patients had moderate cumulative anticholinergic and sedative drug exposure and a mean MMSE of 21.1. MMSE decrease was steeper in patients with moderate and high Drug Burden Index ( -1.74 and -1.70/year, respectively) than in patients with no exposure (-1.26/year) after adjusting for age, education, anxiety and depressive disorders, functional autonomy, and behavioural disorders (p < 0.01).

Conclusions: Long-term exposure to anticholinergic and sedative drugs is associated with steeper cognitive decline. Medication review focusing on de-prescribing these drugs could be implemented early to reduce cognitive impairment.

抗胆碱能药物和镇静药物的累积接触对老年人认知能力的影响:记忆诊所队列研究。
背景:长期接触抗胆碱能药物和镇静药物可能是导致认知能力下降的一个可改变的风险因素。本研究的目的是测量先前累积的抗胆碱能药物和镇静剂药物暴露(药物负担指数)与认知能力下降之间的关系:在法国一家记忆诊所开展了一项队列研究(MEMORA队列),研究对象为2014年11月至2020年12月期间就诊的患者,这些患者至少接受过两次迷你精神状态检查(MMSE)测量(间隔时间≥6个月),并从当地初级医疗保险基金数据库中获得了可用药物数据(n = 1,970)。药物负担指数在每次 MMSE 测量前进行线性累积,并根据患者的暴露水平(无暴露、中度或高度)对其进行分类。使用多变量线性混合模型评估了药物负担指数与MMSE之间的纵向联系,并对年龄、教育水平、焦虑症、抑郁症、功能自主性和行为障碍进行了调整:共纳入 1,970 名患者,平均随访时间为 2.78 年(± 1.54),每名患者随访 2.99 次(共收集 5,900 次 MMSE + 药物负担指数测量)。基线时,68.0%的患者有中度的抗胆碱能和镇静药物累积暴露,平均 MMSE 为 21.1。在对年龄、教育程度、焦虑和抑郁障碍、功能自主性和行为障碍等因素进行调整后,中度和高度药物负担指数患者的 MMSE 下降幅度(分别为-1.74 和-1.70/年)比未接触过药物的患者(-1.26/年)要大(P 结论:长期接触抗胆碱能药物和镇静剂的患者的 MMSE 下降幅度比未接触过抗胆碱能药物和镇静剂的患者要大:长期接触抗胆碱能药物和镇静药物与认知能力的急剧下降有关。可以及早实施以停用这些药物为重点的用药审查,以减少认知障碍。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Alzheimer's Research & Therapy
Alzheimer's Research & Therapy 医学-神经病学
CiteScore
13.10
自引率
3.30%
发文量
172
审稿时长
>12 weeks
期刊介绍: Alzheimer's Research & Therapy is an international peer-reviewed journal that focuses on translational research into Alzheimer's disease and other neurodegenerative diseases. It publishes open-access basic research, clinical trials, drug discovery and development studies, and epidemiologic studies. The journal also includes reviews, viewpoints, commentaries, debates, and reports. All articles published in Alzheimer's Research & Therapy are included in several reputable databases such as CAS, Current contents, DOAJ, Embase, Journal Citation Reports/Science Edition, MEDLINE, PubMed, PubMed Central, Science Citation Index Expanded (Web of Science) and Scopus.
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