Polypharmacy, drug-drug interactions, anticholinergic burden and cognitive outcomes: a snapshot from a community-dwelling sample of older men and women in northern Italy.
Elena Perdixi, Matteo Cotta Ramusino, Alfredo Costa, Sara Bernini, Silvia Conti, Nithiya Jesuthasan, Marco Severgnini, Federica Prinelli
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引用次数: 0
Abstract
Polypharmacy (PP) use is very common in older people and may lead to drug-drug interactions (DDIs) and anticholinergic burden (ACB) that may affect cognitive function. We aimed to determine the occurrence of PP, potential DDIs and ACB and their role in cognitive outcomes in an older population. Cross-sectional data from 636 community-dwelling adults (73.2 ± 6.0 SD, 58.6% women) participating in the NutBrain study (2019-2023) were analyzed. Participants were asked about their medication use, and data on potential DDIs and ACB were extracted. The associations of PP (≥ 5 drugs/day), potential DDIs, and ACB with mild cognitive impairment (MCI) and specific cognitive domains were assessed using logistic regression adjusted for confounders. Sex-stratified analysis was performed. Overall, 27.2% of the participants were exposed to PP, 42.3% to potential DDIs and 19% to cumulative ACB. Women were less exposed to PP and more exposed to ACB than men. In multivariate analysis, the odds of having MCI (24%) were three times higher in those with severe ACB (≥ 3) (OR 3.34, 95%CI 1.35-8.25). ACB was positively associated with poor executive function (OR 4.45, 95%CI 1.72-11.49) and specifically with the Frontal Assessment Battery and neuropsychological tests of phonological and semantic fluency. In sex-stratified analysis, ACB was statistically significantly associated with MCI and executive function in women and with memory in men. PP, potential DDIs and anticholinergics use are very common in community-dwelling older people. ACB exposure is associated with MCI, particularly with poor executive function. Clinicians are encouraged to be vigilant when prescribing anticholinergics.Trial registration: Trial registration number NCT04461951, date of registration July 7, 2020 (retrospectively registered, ClinicalTrials.gov).
期刊介绍:
The European Journal of Ageing: Social, Behavioural and Health Perspectives is an interdisciplinary journal devoted to the understanding of ageing in European societies and the world over.
EJA publishes original articles on the social, behavioral and population health aspects of ageing and encourages an integrated approach between these aspects.
Emphasis is put on publishing empirical research (including meta-analyses), but conceptual papers (including narrative reviews) and methodological contributions will also be considered.
EJA welcomes expert opinions on critical issues in ageing.
By stimulating communication between researchers and those using research findings, it aims to contribute to the formulation of better policies and the development of better practice in serving older adults.
To further specify, with the term ''social'' is meant the full scope of social science of ageing related research from the micro to the macro level of analysis. With the term ''behavioural'' the full scope of psychological ageing research including life span approaches based on a range of age groups from young to old is envisaged. The term ''population health-related'' denotes social-epidemiological and public health oriented research including research on functional health in the widest possible sense.