Susmita Chandramouleeshwaran, Waqas U Khan, Fiona Inglis, Tarek K Rajji
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引用次数: 0
Abstract
Objectives: The aim of this systematic review is to examine the cognitive impact of psychotropic medications including benzodiazepines, antidepressants, mood stabilizers, antipsychotics, or a combination of these drugs on older adults.
Design: Systematic review.
Setting: We searched Medline, PsycINFO, and Embase through the Ovid platform, CINAHL through EBSCO, and Web of Science.
Participants and interventions: Randomized control trials (RCTs) and cohort studies that used a validated scale to measure cognition with a follow-up period of at least six months were included.
Measurement: The primary outcome of interest was cognitive change associated with psychotropic medication use.
Results: A total of 7551 articles were identified from the primary electronic literature search across the five databases after eliminating duplicates. Based on full-text analysis, 27 articles (two RCTs, 25 cohorts) met the inclusion criteria. Of these, nine each examined the impact of benzodiazepines and antidepressants, five examined psychotropic combinations, three on antipsychotic drugs, and one on the effects of mood stabilizers.
Conclusions: This is the first systematic review to examine the cognitive impact of multiple psychotropic drug classes in older adults over an extended follow-up period (six months or more) using robust sample sizes, drug-free control groups, and validated cognitive instruments. We found evidence to indicate cognitive decline with the cumulative use of benzodiazepines and the use of antidepressants, especially those with anticholinergic properties among older adults without cognitive impairment at baseline. Further, the use of antipsychotics and psychotropic combinations is also associated with cognitive decline in older adults.
目的：本系统综述的目的是研究精神药物对老年人的认知影响，包括苯二氮卓类药物、抗抑郁药、情绪稳定剂、抗精神病药物或这些药物的组合。设计：系统审查。设置：我们通过Ovid平台搜索Medline、PsycINFO和Embase，通过EBSCO和Web of Science搜索CINAHL。参与者和干预措施：随机对照试验（RCT）和队列研究，使用经验证的量表测量认知，随访期至少为六个月。测量：感兴趣的主要结果是与精神药物使用相关的认知变化。结果：在消除重复后，从五个数据库的主要电子文献搜索中共识别出7551篇文章。根据全文分析，有27篇文章（2篇随机对照试验，25个队列）符合纳入标准。其中，9项分别检查了苯二氮卓类药物和抗抑郁药的影响，5项检查了精神药物组合，3项检查了抗精神病药物，1项检查了情绪稳定剂的影响。结论：这是首次使用稳健的样本量、无药物对照组和经验证的认知工具，在延长的随访期（六个月或更长时间）内，对多种精神药物类别对老年人的认知影响进行系统审查。我们发现有证据表明，随着苯二氮卓类药物的累积使用和抗抑郁药的使用，认知能力下降，尤其是那些在基线时没有认知障碍的老年人中具有抗胆碱能特性的人。此外，抗精神病药物和精神药物组合的使用也与老年人的认知能力下降有关。
期刊介绍：
A highly respected, multidisciplinary journal, International Psychogeriatrics publishes high quality original research papers in the field of psychogeriatrics. The journal aims to be the leading peer reviewed journal dealing with all aspects of the mental health of older people throughout the world. Circulated to over 1,000 members of the International Psychogeriatric Association, International Psychogeriatrics also features important editorials, provocative debates, literature reviews, book reviews and letters to the editor.
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