Drug burden index of people ageing with intellectual disability and cognitive complaints attending a specialist memory service

IF 2.1 2区医学 Q1 EDUCATION, SPECIAL Journal of Intellectual Disability Research Pub Date : 2024-08-26 DOI:10.1111/jir.13180

R. M. Vaughan, M. O'Dwyer, J. Tyrrell, S. P. Kennelly, M. McCarron

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Abstract

Background

Medications with sedative or anticholinergic properties should be prescribed with caution in those with cognitive complaints. This is particularly relevant in people ageing with an intellectual disability (ID). Higher drug burden index (DBI) scores are associated with increased frailty and falls and reduced quality of life in older people and increased risk of adverse effects (daytime somnolence, constipation) in those with ID. While previous studies have shown that the ID population has higher rates of drug burden and a higher propensity to be prescribed an antipsychotic than the general population, the degree of burden has not been assessed specifically in those with ID and cognitive complaints.

Methods

We assessed drug burden in a cohort of sequential referrals to a national memory service for people with ID. All patients were referred for assessment of cognitive complaints (self-reported or caregiver-reported problems with memory or cognition). DBI was calculated individually for each participant, and the impact of aetiology of ID, level of ID, age, psychiatric/neurological comorbidities and diagnostic outcome on DBI scores was assessed.

Results

The study population was 58.6% female with a median age of 55 years and aetiology of ID was Down syndrome (DS) in 71.3%. Consensus diagnosis was Alzheimer's dementia in 40.2%, mild cognitive impairment in 29.9% and cognitively unimpaired from baseline in 25.3%. Medication use was high with 95.4% taking medications, with a median number of medications of 4 (interquartile range 4) and a rate of polypharmacy (≥5 medications) of 51.7%. Overall, 65.5% were exposed to sedative or anticholinergic medications with 39.1% exposed to a clinically significant DBI score >1. Those with psychiatric comorbidities, non-DS aetiology or epilepsy were significantly more likely to have a DBI score >1.

Conclusions

People with ID and incipient cognitive complaints have a high level of drug burden, which concerningly exceeds that of the general population.

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接受记忆专科服务的智障和认知障碍老年人的药物负担指数。

背景：对于有认知障碍的患者，应慎用具有镇静或抗胆碱能特性的药物。这一点对于患有智力障碍（ID）的老年人尤为重要。药物负担指数（DBI）得分越高，老年人体弱、跌倒和生活质量下降的情况就越多，智障人士出现不良反应（白天嗜睡、便秘）的风险也越高。以往的研究表明，与普通人群相比，智障人群的药物负担率更高，被处方抗精神病药物的倾向性也更高，但还没有专门针对智障和认知障碍患者的药物负担程度进行过评估：我们评估了一组连续转诊至国家记忆服务机构的智障人士的药物负担。所有转诊患者均接受了认知症状评估（自我报告或护理人员报告的记忆或认知问题）。对每位参与者的 DBI 进行单独计算，并评估智障病因、智障程度、年龄、精神/神经系统合并症和诊断结果对 DBI 分数的影响：研究对象中 58.6% 为女性，中位年龄为 55 岁，71.3% 的 ID 病因是唐氏综合征（DS）。40.2%的人被确诊为阿尔茨海默氏痴呆症，29.9%的人被确诊为轻度认知障碍，25.3%的人被确诊为基线认知功能未受损。药物使用率很高，95.4% 的人在服药，药物中位数为 4 种（四分位间范围为 4），多药（≥5 种药物）率为 51.7%。总体而言，65.5%的患者服用镇静剂或抗胆碱能药物，39.1%的患者服用具有临床意义的DBI评分>1：结论：患有智障和初期认知障碍的患者的药物负担很重，超过了普通人群的药物负担，令人担忧。

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来源期刊

Journal of Intellectual Disability Research Multiple-

CiteScore

5.60

自引率

5.60%

发文量

期刊介绍： The Journal of Intellectual Disability Research is devoted exclusively to the scientific study of intellectual disability and publishes papers reporting original observations in this field. The subject matter is broad and includes, but is not restricted to, findings from biological, educational, genetic, medical, psychiatric, psychological and sociological studies, and ethical, philosophical, and legal contributions that increase knowledge on the treatment and prevention of intellectual disability and of associated impairments and disabilities, and/or inform public policy and practice. Expert reviews on themes in which recent research has produced notable advances will be included. Such reviews will normally be by invitation.