Abstract：
BACKGROUND: Anticholinergic and sedative medications affect cognition among older adults. The Drug Burden Index (DBI) is a validated measure of exposure to these medications, with higher DBI scores indicating higher drug burden. This ancillary analysis investigated the association between DBI and cognition assessed by the Modified Mini-Mental State Examination (3MS) and the Digit Symbol Substitution Test (DSST).
METHODS: The Health, Aging, and Body Composition Study was a prospective study of community-dwelling adults aged 70-79 years at enrollment. Using data from years 1, 5, and 10, DBI was calculated using medication data per participant. Linear mixed modeling was used to assess cross-sectional and longitudinal effects of DBI on 3MS and DSST. Adjusted models included biological sex, race, education level, APOE status, and death. Sensitivity analyses included testing the strength of the associations for each year and testing attrition due to death as a possible confounding factor via Cox-Proportional Hazard models.
RESULTS: After adjustment, DBI was inversely associated with 3MS and DSST scores. These associations became stronger in each subsequent year. Neither DBI at year 1 nor within-person change in DBI were predictive of longitudinal declines in either cognitive measure. Sensitivity analyses indicated that DBI, 3MS, and DSST were associated with a greater risk of attrition due to death.
CONCLUSIONS: Results suggest that in years when older adults had a higher DBI scores, they had significantly lower global cognition and slower processing speed. These findings further substantiate the DBI as a useful pharmacological tool for assessing the effect of medication exposure.
METHODS: The Health, Aging, and Body Composition Study was a prospective study of community-dwelling adults aged 70-79 years at enrollment. Using data from years 1, 5, and 10, DBI was calculated using medication data per participant. Linear mixed modeling was used to assess cross-sectional and longitudinal effects of DBI on 3MS and DSST. Adjusted models included biological sex, race, education level, APOE status, and death. Sensitivity analyses included testing the strength of the associations for each year and testing attrition due to death as a possible confounding factor via Cox-Proportional Hazard models.
RESULTS: After adjustment, DBI was inversely associated with 3MS and DSST scores. These associations became stronger in each subsequent year. Neither DBI at year 1 nor within-person change in DBI were predictive of longitudinal declines in either cognitive measure. Sensitivity analyses indicated that DBI, 3MS, and DSST were associated with a greater risk of attrition due to death.
CONCLUSIONS: Results suggest that in years when older adults had a higher DBI scores, they had significantly lower global cognition and slower processing speed. These findings further substantiate the DBI as a useful pharmacological tool for assessing the effect of medication exposure.
摘要：
背景：抗胆碱能和镇静药物会影响老年人的认知功能。药物负担指数（DBI）是对这些药物暴露的有效测量，DBI评分较高表明药物负担较高。此辅助分析研究了DBI与通过改良迷你精神状态检查（3MS）和数字符号替代测试（DSST）评估的认知之间的关联。
方法：健康，衰老,和身体成分研究是一项前瞻性研究，研究对象为社区居住的70-79岁的成年人。使用第1、5和10年的数据，使用每个参与者的药物数据计算DBI。线性混合模型用于评估DBI对3MS和DSST的横截面和纵向影响。调整后的模型包括生物性别，种族,教育水平,APOE状态,和死亡。敏感性分析包括测试每年的关联强度，并通过Cox比例风险模型测试由于死亡而导致的减员作为可能的混杂因素。
结果：调整后，DBI与3MS和DSST评分呈负相关。这些协会在随后的每一年都变得更加强大。第1年的DBI和DBI的内部变化都不能预测两种认知指标的纵向下降。敏感性分析表明，DBI，3MS,和DSST与更大的死亡减员风险相关。
结论：结果表明，在老年人DBI评分较高的年份，他们具有显著较低的全球认知和较慢的处理速度。这些发现进一步证实DBI是评估药物暴露效果的有用药理学工具。
方法：健康，衰老,和身体成分研究是一项前瞻性研究，研究对象为社区居住的70-79岁的成年人。使用第1、5和10年的数据，使用每个参与者的药物数据计算DBI。线性混合模型用于评估DBI对3MS和DSST的横截面和纵向影响。调整后的模型包括生物性别，种族,教育水平,APOE状态,和死亡。敏感性分析包括测试每年的关联强度，并通过Cox比例风险模型测试由于死亡而导致的减员作为可能的混杂因素。
结果：调整后，DBI与3MS和DSST评分呈负相关。这些协会在随后的每一年都变得更加强大。第1年的DBI和DBI的内部变化都不能预测两种认知指标的纵向下降。敏感性分析表明，DBI，3MS,和DSST与更大的死亡减员风险相关。
结论：结果表明，在老年人DBI评分较高的年份，他们具有显著较低的全球认知和较慢的处理速度。这些发现进一步证实DBI是评估药物暴露效果的有用药理学工具。
