有认知障碍的老年人开始服用加巴喷丁与认知和行为变化的关系:一项回顾性队列研究

IF 3.4 3区 医学 Q2 GERIATRICS & GERONTOLOGY
Drugs & Aging Pub Date : 2024-07-01 Epub Date: 2024-07-09 DOI:10.1007/s40266-024-01130-z
GYeon Oh, Daniela C Moga, David W Fardo, Jordan P Harp, Erin L Abner
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引用次数: 0

摘要

背景:尽管越来越多的老年人服用加巴喷丁,但人们对开始服用加巴喷丁与长期神经认知变化之间的关系还不甚了解。因此,本研究旨在探讨开始服用加巴喷丁与患有认知障碍的老年人的认知和运动功能衰退之间的关系:采用国家阿尔茨海默氏症协调中心统一数据集(2005 年至 2023 年 3 月)进行了一项回顾性队列研究。研究纳入了在开始服用加巴喷丁时患有认知障碍的参试者(即指标参试者)。采用发病密度抽样法,为每位初始患者随机抽取多达 9 位非使用者。一年内认知能力下降的定义是临床痴呆评分总分(CDR®GLOB)增加或CDR®方框总和(CDR®SB)增加1分。一年内功能状态下降的定义是:功能活动问卷(FAQ)总和至少增加 3 分,或 FAQ 平均值增加 0.3 分。一年内运动能力下降的定义是临床医生新报告的步态障碍、跌倒和行动迟缓。为减少混杂因素和选择偏差,采用了联合稳定反向治疗概率权重和普查权重。分析比较了指数与指数 + 1 和指数 + 2 访问:在认知和功能状态下降的研究中,我们纳入了 505 名初始使用者(平均年龄 [SD] 78.8 [7.4];男性 = 45%)和 4545 名非使用者(79.2 [7.6];50.1%)。在运动能力下降的研究中,我们纳入了 353 名初始患者(78.3 [7.2];42.8%)和 3177 名非患者(78.5 [7.4];48.1%)。在统计学上,加巴喷丁的使用与指数 + 1 或指数 + 2 访问时 CDR®GLOB、CDR®SB、常见问题总和或平均常见问题的下降无关。然而,开始使用加巴喷丁与指数+2访视时发生新跌倒的几率增加显著相关(几率比[95% 置信区间] 2.5 [1.3, 4.6]):在1年或2年的随访中,开始服用加巴喷丁与认知或功能状态的下降无关,但与认知障碍研究参与者跌倒几率的增加有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

The Association of Gabapentin Initiation with Cognitive and Behavioral Changes in Older Adults with Cognitive Impairment: A Retrospective Cohort Study.

The Association of Gabapentin Initiation with Cognitive and Behavioral Changes in Older Adults with Cognitive Impairment: A Retrospective Cohort Study.

Background: Although gabapentin has been increasingly prescribed to older adults, the relation between gabapentin initiation and longer-term neurocognitive changes is not well understood. Thus, this study aimed to examine the association of gabapentin initiation with cognitive and motor function decline in older adult participants with cognitive impairment.

Methods: A retrospective cohort study was conducted using the National Alzheimer's Coordinating Center Uniform Data Set (2005-March 2023). Participants with cognitive impairment at the visit of gabapentin initiation (i.e., index visit) were included. Using the incidence density sampling method, up to nine non-users were randomly selected for each initiator. Cognitive decline over 1 year was defined as any increase in Clinical Dementia Rating global score (CDR®GLOB) or a 1-point increase in CDR® sum of boxes (CDR®SB). Functional status decline over 1 year was defined as at least a 3-point increase in the Functional Activities Questionnaire (FAQ) sum or a 0.3-point increase of mean of FAQ. Motoric decline over 1 year was defined as new clinician reports of gait disorder, falls, and slowness. To mitigate confounding and selection bias, joint stabilized inverse probability of treatment weights and censoring weights were used. Analyses compared index with index + 1 and index + 2 visits.

Results: For the study of cognitive and functional status decline, we included 505 initiators (mean age [SD] 78.8 [7.4]; male = 45%) and 4545 non-users (79.2 [7.6]; 50.1%). For the study of motor decline, we included 353 initiators (78.3 [7.2]; 42.8%) and 3177 non-users (78.5 [7.4]; 48.1%). Gabapentin initiation was not statistically associated with decline on CDR®GLOB, CDR®SB, FAQ sum, or mean FAQ at the index + 1 or index + 2 visits. However, gabapentin initiation was significantly associated with increased odds of new falls at the index + 2 visit (odds ratio [95% confidence interval] 2.5 [1.3, 4.6]).

Conclusions: Over 1 or 2 years of follow-up, gabapentin initiation was not associated with decline in cognitive or functional status but was associated with increased odds of falling among research participants with cognitive impairment.

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来源期刊
Drugs & Aging
Drugs & Aging 医学-老年医学
CiteScore
5.50
自引率
7.10%
发文量
68
审稿时长
6-12 weeks
期刊介绍: Drugs & Aging delivers essential information on the most important aspects of drug therapy to professionals involved in the care of the elderly. The journal addresses in a timely way the major issues relating to drug therapy in older adults including: the management of specific diseases, particularly those associated with aging, age-related physiological changes impacting drug therapy, drug utilization and prescribing in the elderly, polypharmacy and drug interactions.
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