阿尔茨海默病的药物治疗和认知能力下降:15428例患者的队列聚类分析

IF 3.4 3区 医学 Q2 NEUROSCIENCES Journal of Alzheimer's Disease Pub Date : 2025-01-08 DOI:10.1177/13872877241307870
Pol Grau-Jurado, Shayan Mostafaei, Hong Xu, Minjia Mo, Bojana Petek, Irena Kalar, Luana Naia, Julianna Kele, Silvia Maioli, Joana B Pereira, Maria Eriksdotter, Saikat Chatterjee, Sara Garcia-Ptacek
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引用次数: 0

摘要

背景:合并症的药物治疗可能影响阿尔茨海默病(AD)的认知。目的:探讨常用药物治疗与认知能力的关系。方法:队列研究包括来自瑞典认知/痴呆障碍登记处(SveDem)的AD患者。≥5%的患者(26种单独的药物)使用的药物被纳入。通过进行100次蒙特卡罗模拟,对每个随访进行独立分析,每两个步骤1)根据随访时的迷你精神状态检查及其自上次测量以来的下降情况对患者进行k-means聚类,2)识别不同聚类中使用者比例具有统计学显著差异的药物。结果:共纳入15428例患者,其中女性占60.38%。确定了四个集群。与认知类最佳相关的药物为阿托伐他汀(第一次随访时点估计1.44 95%置信区间[1.15-1.83],第二次随访时辛伐他汀(1.41[1.11-1.78])、华法林(1.56[1.22-2.01])、佐匹克隆(1.35[1.15-1.58])、二甲双胍(2.08[1.35-3.33])。恶西泮(0.60[0.50-0.73])、扑热息痛(0.83[0.73-0.95])、氰钴胺素、非洛地平和呋塞米与最差聚类相关。胆碱酯酶抑制剂与最佳认知集群相关,而美金刚出现在较差的认知集群中,这与它在中重度痴呆中的适应症一致。结论:我们进行了无监督聚类,根据患者当前的认知能力和先前测试的认知能力下降对患者进行分类。阿托伐他汀、辛伐他汀、华法林、二甲双胍和佐匹龙与认知呈正相关且有统计学意义,而恶西泮、氰钴胺素、非洛地平、呋塞米和扑热息痛与最差集群相关。
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Medications and cognitive decline in Alzheimer's disease: Cohort cluster analysis of 15,428 patients.

Background: Medications for comorbid conditions may affect cognition in Alzheimer's disease (AD).

Objective: To explore the association between common medications and cognition, measured with the Mini-Mental State Examination.

Methods: Cohort study including persons with AD from the Swedish Registry for Cognitive/Dementia Disorders (SveDem). Medications were included if they were used by ≥5% of patients (26 individual drugs). Each follow-up was analyzed independently by performing 100 Monte-Carlo simulations of two steps each 1) k-means clustering of patients according to Mini-Mental State Examination at follow-up and its decline since previous measure, and 2) Identification of medications presenting statistically significant differences in the proportion of users in the different clusters.

Results: 15,428 patients (60.38% women) were studied. Four clusters were identified. Medications associated with the best cognition cluster (relative to the worse) were atorvastatin (point estimate 1.44 95% confidence interval [1.15-1.83] at first follow-up, simvastatin (1.41 [1.11-1.78] at second follow-up), warfarin (1.56 [1.22-2.01] first follow-up), zopiclone (1.35 [1.15-1.58], and metformin (2.08 [1.35-3.33] second follow-up. Oxazepam (0.60 [0.50-0.73] first follow-up), paracetamol (0.83 [0.73-0.95] first follow-up), cyanocobalamin, felodipine and furosemide were associated with the worst cluster. Cholinesterase inhibitors were associated with the best cognition clusters, whereas memantine appeared in the worse cognition clusters, consistent with its indication in moderate to severe dementia.

Conclusions: We performed unsupervised clustering to classify patients based on their current cognition and cognitive decline from previous testing. Atorvastatin, simvastatin, warfarin, metformin, and zopiclone presented a positive and statistically significant associations with cognition, while oxazepam, cyanocobalamin, felodipine, furosemide and paracetamol, were associated with the worst cluster.

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来源期刊
Journal of Alzheimer's Disease
Journal of Alzheimer's Disease 医学-神经科学
CiteScore
6.40
自引率
7.50%
发文量
1327
审稿时长
2 months
期刊介绍: The Journal of Alzheimer''s Disease (JAD) is an international multidisciplinary journal to facilitate progress in understanding the etiology, pathogenesis, epidemiology, genetics, behavior, treatment and psychology of Alzheimer''s disease. The journal publishes research reports, reviews, short communications, hypotheses, ethics reviews, book reviews, and letters-to-the-editor. The journal is dedicated to providing an open forum for original research that will expedite our fundamental understanding of Alzheimer''s disease.
期刊最新文献
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