Mild polypharmacy and MCI progression in older adults: the mediation effect of drug-drug interactions.
Anticholinergic cognitive burden
Dementia
Drug interactions
Mild cognitive impairment
Polypharmacy
Journal
Aging clinical and experimental research
ISSN: 1720-8319
Titre abrégé: Aging Clin Exp Res
Pays: Germany
ID NLM: 101132995
Informations de publication
Date de publication:
Jan 2021
Jan 2021
Historique:
received:
05
09
2019
accepted:
12
11
2019
pubmed:
24
11
2019
medline:
24
2
2021
entrez:
24
11
2019
Statut:
ppublish
Résumé
Polypharmacy has been associated with worse cognitive performance, but its impact on mild cognitive impairment (MCI) progression to dementia has not been explored. The aims of the study were to investigate the association between multidrug regimens and MCI progression, and the possible mediation of drug-drug interactions and drugs' anticholinergic effect in such association. This work included 342 older adults with MCI, who were involved in an Italian multicenter population-based cohort study. Information on drugs taken was derived from general practitioners' records and data on drug-drug interactions and anticholinergic burden [evaluated through the Anticholinergic Cognitive Burden and the Anticholinergic Risk Scale (ARS)] were extracted. Multinomial logistic regressions assessed the associations between mild polypharmacy (≥ 3 drugs/day), drug-drug interactions, and anticholinergic burden with MCI changes after 1-year follow-up. Mediation analysis evaluated potential mediators of that relationship. Approximately, 50% of participants took ≥ 3 drugs/day. During the follow-up, 4.1% of MCI patients progressed to dementia. The odds of developing dementia was sixfold higher in those who took ≥ 3drugs/day (OR = 6.04, 95% CI 1.19-30.74), eightfold higher in those with ≥ 1 drug-drug interaction/s (OR = 8.45, 95% CI 1.70-41.91), and fivefold higher in those with ARS ≥ 1 (OR = 5.10, 95% CI 1.04-24.93). Drug-drug interactions mediated 70.4% of the association between medication number and MCI progression to dementia (p = 0.07). Our study suggests that even mild polypharmacy may increase the risk of MCI progression to dementia, probably due to the presence of drug-drug interactions, which often occur in multidrug regimens. Older people require careful management of pharmacological treatments, with special attention to drug-drug interactions and drug-related anticholinergic effects.
Sections du résumé
BACKGROUND
BACKGROUND
Polypharmacy has been associated with worse cognitive performance, but its impact on mild cognitive impairment (MCI) progression to dementia has not been explored.
AIMS
OBJECTIVE
The aims of the study were to investigate the association between multidrug regimens and MCI progression, and the possible mediation of drug-drug interactions and drugs' anticholinergic effect in such association.
METHODS
METHODS
This work included 342 older adults with MCI, who were involved in an Italian multicenter population-based cohort study. Information on drugs taken was derived from general practitioners' records and data on drug-drug interactions and anticholinergic burden [evaluated through the Anticholinergic Cognitive Burden and the Anticholinergic Risk Scale (ARS)] were extracted. Multinomial logistic regressions assessed the associations between mild polypharmacy (≥ 3 drugs/day), drug-drug interactions, and anticholinergic burden with MCI changes after 1-year follow-up. Mediation analysis evaluated potential mediators of that relationship.
RESULTS
RESULTS
Approximately, 50% of participants took ≥ 3 drugs/day. During the follow-up, 4.1% of MCI patients progressed to dementia. The odds of developing dementia was sixfold higher in those who took ≥ 3drugs/day (OR = 6.04, 95% CI 1.19-30.74), eightfold higher in those with ≥ 1 drug-drug interaction/s (OR = 8.45, 95% CI 1.70-41.91), and fivefold higher in those with ARS ≥ 1 (OR = 5.10, 95% CI 1.04-24.93). Drug-drug interactions mediated 70.4% of the association between medication number and MCI progression to dementia (p = 0.07).
DISCUSSION
CONCLUSIONS
Our study suggests that even mild polypharmacy may increase the risk of MCI progression to dementia, probably due to the presence of drug-drug interactions, which often occur in multidrug regimens.
CONCLUSIONS
CONCLUSIONS
Older people require careful management of pharmacological treatments, with special attention to drug-drug interactions and drug-related anticholinergic effects.
Identifiants
pubmed: 31758500
doi: 10.1007/s40520-019-01420-2
pii: 10.1007/s40520-019-01420-2
doi:
Substances chimiques
Pharmaceutical Preparations
0
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
49-56Subventions
Organisme : Special Program of the Ministry of Health
ID : Special program ex art. 12
Organisme : Special Program of the Ministry of Health
ID : comma 2
Organisme : Special Program of the Ministry of Health
ID : lett B D.Lvo n. 502/92
Organisme : National Research Council of Italy (CNR)
ID : Prot. MIUR 2867 25.11.2011
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