抗胆碱能药物负担与老年动脉高血压患者的认知功能

O. D. Ostroumova, K. K. Dzamikhov, A. I. Kochetkov, Т. M. Ostroumova, E. Y. Ebzeyeva, А. I. Andrianov, V. B. Dashabylova
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All the patients were underwent the assesment of CF using the Montreal Cognitive Assessment Scale (MoCA), Mini-Mental Status Scale (MMS), Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-cog), Trial Making Test (TMT), Digit Symbol Substitution Test (DSST), Verbal Association Test (literal (letter) and categorical (animal) associations), Boston Naming Test (BNT), Word-Color Interference Test, Stroop colorword conflict test. The anticholinergic load was determined using the anticholinergic load scale (Anticholinergic Cognitive Burden Scale, ACB).Results. 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引用次数: 0

摘要

该研究旨在评估抗胆碱能负荷(AHN)对老年多病动脉高血压(AH)患者认知功能(CF)的影响。研究共纳入 330 名 60 岁及以上的基本动脉高血压患者(中位年龄 79 [72; 84] 岁,女性 158 人(51%))。所有患者均使用蒙特利尔认知评估量表 (MoCA)、迷你精神状态量表 (MMS)、阿尔茨海默病认知评估量表 (ADAS-cog)、试做测试 (TMT)、数字符号替换测试 (DSST)、言语联想测试(字面联想(字母)和分类联想(动物))、波士顿命名测试 (BNT)、词-色干扰测试、Stroop 色词冲突测试进行了 CF 评估。使用抗胆碱能负荷量表(抗胆碱能认知负荷量表,ACB)确定抗胆碱能负荷。与未服用抗胆碱能药物的患者相比,ACB量表上有2个或更多点的多病老年和老年高血压患者在MoCA测试(分别为23 [21; 24.3] 点和24 [22; 25] 点,P=0.042)和 MMSE(分别为 26 [24; 29] 分 vs. 27.5 [25; 29] 分,p=0.015),他们完成 TMT 测试 B 部分所花费的时间在统计学上更长(分别为 217.5 [187.3; 246.3] 秒 vs. 204 [166.8; 247.3] 秒,p=0.038)。在统计学上,ACB 量表上有 2 点或更多点的患者执行 TMT 测试 B 部分和 A 部分所需的时间差异明显大于该量表上只有 0 点的患者(分别为 141 [103.8; 168.5] 秒对 124 [83.8; 162] 秒,P=0.034)。两组患者的年龄、性别、教育程度和伴随疾病的结构没有差异。研究结果表明,抗胆碱能药物对多病老年高血压患者的CF有不利影响,因此需要优化这类患者的药物治疗。
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Anticholinergic burden and the cognitive functions in elderly and senile patients with arterial hypertension
The aim of the study was to evaluate the effect of anticholinergic load (AHN) on cognitive functions (CF) in elderly and senile multimorbid patients with arterial hypertension (AH).Materials and methods. 330 patients aged 60 years and older with essential AH were included in the study (median age 79 [72; 84] years, 158 (51 %) of women). All the patients were underwent the assesment of CF using the Montreal Cognitive Assessment Scale (MoCA), Mini-Mental Status Scale (MMS), Alzheimer’s Disease Assessment Scale-Cognitive (ADAS-cog), Trial Making Test (TMT), Digit Symbol Substitution Test (DSST), Verbal Association Test (literal (letter) and categorical (animal) associations), Boston Naming Test (BNT), Word-Color Interference Test, Stroop colorword conflict test. The anticholinergic load was determined using the anticholinergic load scale (Anticholinergic Cognitive Burden Scale, ACB).Results. Compared with patients who do not take anticholinergic drugs, multimorbid elderly and senile hypertensive patients with 2 or more points on the ACB scale had significantly lower final scores on the MoCA test (23 [21; 24.3] versus 24 [22; 25] points, respectively, p=0.042) and on MMSE (26 [24; 29] vs. 27.5 [25; 29] points, respectively, p=0.015), they spent statistically more time completing part B of the TMT test (217.5 [187.3; 246.3] vs. 204 [166.8; 247.3] seconds, respectively, p=0.038). The difference between the execution time of part B and part A of the TMT test in patients with 2 or more points on the ACB scale was statistically significantly greater than in patients with 0 points on this scale (141 [103.8; 168.5] versus 124 [83.8; 162] sec, respectively, p=0.034). Age, gender, education, and the structure of concomitant diseases did not differ between the groups.Conclusion. The results obtained indicate the adverse effect of аnticholinergic вurden on CF of multimorbid elderly and senile hypertensive patients and dictate the need to optimize pharmacotherapy in this category of patients.
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