Polypharmacy, drug-drug interactions, anticholinergic burden and cognitive outcomes: a snapshot from a community-dwelling sample of older men and women in northern Italy.

IF 3.7 2区 社会学 Q1 GERONTOLOGY European Journal of Ageing Pub Date : 2024-03-29 DOI:10.1007/s10433-024-00806-0
Elena Perdixi, Matteo Cotta Ramusino, Alfredo Costa, Sara Bernini, Silvia Conti, Nithiya Jesuthasan, Marco Severgnini, Federica Prinelli
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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).

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多药合用、药物间相互作用、抗胆碱能药物负担和认知结果:意大利北部社区老年男性和女性样本快照。
多药合用(PP)在老年人中非常常见,可能会导致药物间相互作用(DDI)和抗胆碱能负担(ACB),从而影响认知功能。我们旨在确定老年人群中 PP 的发生率、潜在的 DDI 和 ACB 以及它们在认知结果中的作用。我们分析了参与坚果脑研究(2019-2023年)的636名社区居住成年人(73.2 ± 6.0 SD,58.6%为女性)的横断面数据。研究人员询问了参与者的用药情况,并提取了潜在的DDIs和ACB数据。使用逻辑回归评估了PP(≥5种药物/天)、潜在DDIs和ACB与轻度认知障碍(MCI)和特定认知领域的关系,并对混杂因素进行了调整。研究还进行了性别分层分析。总体而言,27.2%的参与者暴露于PP,42.3%暴露于潜在DDI,19%暴露于累积ACB。与男性相比,女性暴露于 PP 的比例较低,而暴露于 ACB 的比例较高。在多变量分析中,严重 ACB(≥ 3)者患 MCI(24%)的几率是男性的三倍(OR 3.34,95%CI 1.35-8.25)。ACB 与较差的执行功能呈正相关(OR 4.45,95%CI 1.72-11.49),特别是与额叶评估电池以及语音和语义流畅性的神经心理学测试呈正相关。在性别分层分析中,ACB 在统计学上与女性 MCI 和执行功能显著相关,与男性记忆力显著相关。在社区居住的老年人中,PP、潜在的DDIs和抗胆碱能药物的使用非常普遍。接触 ACB 与 MCI 相关,尤其是与执行功能低下相关。我们鼓励临床医生在开具抗胆碱能药物处方时保持警惕:试验注册号为NCT04461951,注册日期为2020年7月7日(回顾性注册,ClinicalTrials.gov)。
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来源期刊
CiteScore
6.50
自引率
7.90%
发文量
72
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.
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