Abstract：
BACKGROUND: The purpose of this study was to investigate the relationship between anticholinergic burden (ACB), and cognitive and functional alterations in patients with dementia of Lewy bodies (DLB) during a 1-year follow-up period.
METHODS: This cohort study included patients diagnosed with DLB admitted to a tertiary geriatric outpatient clinic. Cognition, functional performance, and nutritional status were assessed at baseline, 6 months, and 12 months during the follow-up period. The ACB was evaluated, and participants were grouped as ACB ≥1 and ACB=0.
RESULTS: A total of 112 patients with DLB (mean age, 79.3 ± 6.8 years; 50.9% female) were included. The mean number of medications was 5.1 ± 4, 56.9% of participants had polypharmacy, and 55.2% had an anticholinergic drug burden. Individuals with ACB ≥1 had lower instrumental activities of daily living (IADL) scores at baseline than those with ACB=0 (P=0.014). The Barthel index and Lawton-Brody IADL scores significantly decreased in the ACB ≥1 group on repetitive measurements over time, whereas only the Lawton-Brody IADL scores worsened in the ACB=0 group (all P<0.001). There were no significant differences in cognitive scores and Mini-Mental State Examination subdomains between the groups. The dependent variable repetitive test revealed a significant deterioration in the orientation subdomain in the ACB ≥1 group over time (P=0.001). Multivariable regression models showed no significant effect of ACB score on cognitive and functional impairment.
CONCLUSIONS: Our study provides evidence that the use of anticholinergic drugs in this vulnerable population may potentially increase the morbidity by adversely affecting functional status and cognitive orientation.
METHODS: This cohort study included patients diagnosed with DLB admitted to a tertiary geriatric outpatient clinic. Cognition, functional performance, and nutritional status were assessed at baseline, 6 months, and 12 months during the follow-up period. The ACB was evaluated, and participants were grouped as ACB ≥1 and ACB=0.
RESULTS: A total of 112 patients with DLB (mean age, 79.3 ± 6.8 years; 50.9% female) were included. The mean number of medications was 5.1 ± 4, 56.9% of participants had polypharmacy, and 55.2% had an anticholinergic drug burden. Individuals with ACB ≥1 had lower instrumental activities of daily living (IADL) scores at baseline than those with ACB=0 (P=0.014). The Barthel index and Lawton-Brody IADL scores significantly decreased in the ACB ≥1 group on repetitive measurements over time, whereas only the Lawton-Brody IADL scores worsened in the ACB=0 group (all P<0.001). There were no significant differences in cognitive scores and Mini-Mental State Examination subdomains between the groups. The dependent variable repetitive test revealed a significant deterioration in the orientation subdomain in the ACB ≥1 group over time (P=0.001). Multivariable regression models showed no significant effect of ACB score on cognitive and functional impairment.
CONCLUSIONS: Our study provides evidence that the use of anticholinergic drugs in this vulnerable population may potentially increase the morbidity by adversely affecting functional status and cognitive orientation.
摘要：
背景：这项研究的目的是调查抗胆碱能负荷（ACB）之间的关系，路易体痴呆（DLB）患者在1年随访期间的认知和功能改变。
方法：该队列研究包括在三级老年门诊就诊的诊断为DLB的患者。认知,功能性能，在基线时评估营养状况，6个月,随访期间为12个月。对ACB进行了评估，参与者分为ACB≥1，ACB=0。
结果：总共112例DLB患者（平均年龄，79.3±6.8岁；50.9%女性）被包括在内。药物的平均数量为5.1±4，56.9％的参与者有多重用药，55.2%有抗胆碱能药物负担。ACB≥1的个体在基线时的工具日常生活活动能力（IADL）评分低于ACB=0的个体（P=0.014）。随着时间的推移，在ACB≥1组中，Barthel指数和Lawton-BrodyIADL得分显着降低，而只有Lawton-BrodyIADL评分在ACB=0组恶化(均P<0.001)。两组之间的认知评分和简易精神状态检查子领域没有显着差异。因变量重复检验显示，随着时间的推移，ACB≥1组的定向子域显着恶化（P=0.001）。多因素回归模型显示ACB评分对认知和功能损害无显著影响。
结论：我们的研究提供了证据，证明在该脆弱人群中使用抗胆碱能药物可能会通过对功能状态和认知取向产生不利影响而潜在地增加发病率。
方法：该队列研究包括在三级老年门诊就诊的诊断为DLB的患者。认知,功能性能，在基线时评估营养状况，6个月,随访期间为12个月。对ACB进行了评估，参与者分为ACB≥1，ACB=0。
结果：总共112例DLB患者（平均年龄，79.3±6.8岁；50.9%女性）被包括在内。药物的平均数量为5.1±4，56.9％的参与者有多重用药，55.2%有抗胆碱能药物负担。ACB≥1的个体在基线时的工具日常生活活动能力（IADL）评分低于ACB=0的个体（P=0.014）。随着时间的推移，在ACB≥1组中，Barthel指数和Lawton-BrodyIADL得分显着降低，而只有Lawton-BrodyIADL评分在ACB=0组恶化(均P<0.001)。两组之间的认知评分和简易精神状态检查子领域没有显着差异。因变量重复检验显示，随着时间的推移，ACB≥1组的定向子域显着恶化（P=0.001）。多因素回归模型显示ACB评分对认知和功能损害无显著影响。
结论：我们的研究提供了证据，证明在该脆弱人群中使用抗胆碱能药物可能会通过对功能状态和认知取向产生不利影响而潜在地增加发病率。
