痴呆症患者使用抗抑郁药和认知能力下降:一项国家队列研究
Minjia Mo1, Tamar Abzhandadze2,3, Minh Tuan Hoang2,4
1Division of Clinical Geriatrics, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Blickagången 16, Stockholm, 14152, Sweden. minjia.mo.2@ki.se.
BMC medicine
|February 25, 2025
概括
痴呆症患者使用抗抑郁药与更快的认知衰退有关. 高剂量的选择性血清素再吸收抑制剂 (SSRI) 增加了严重痴呆,骨折和死亡的风险.
科学领域:
- 神经学 神经学
- 精神病学是一个精神病学.
- 药理学 药理学是指药理学的学科.
背景情况:
- 痴呆症经常表现为精神症状,但抗抑郁药对痴呆患者认知功能的影响仍未得到充分研究.
- 现有研究尚未充分探索各种抗抑郁药类,剂量和痴呆症患者的不良结果之间的关系.
研究的目的:
- 调查抗抑郁药使用与痴呆症患者认知衰退之间的关联.
- 评估与不同类型,药物和剂量的抗抑郁药物相关的严重痴呆,骨折和死亡率的风险.
主要方法:
- 一项国家队列研究,利用瑞典认知/痴呆障碍登记处 (SveDem) 从2007年5月到2018年10月的数据.
- 线性混合模型分析了认知轨迹 (迷你精神状态检查得分),而Cox比例危险模型评估了严重痴呆,骨折和死亡的风险.
- 在诊断或随访前六个月内,抗抑郁药物暴露被评估为时间变量,比较不同类别,药物和剂量.
主要成果:
- 该研究包括18740名痴呆症患者,其中22.8%使用抗抑郁药,主要是选择性血清素再吸收抑制剂 (SSRI).
- 抗抑郁药的使用与加速的认知衰退相关 (β = -0.30点/年),而特定药物如埃斯基塔洛普拉姆和西塔洛普拉姆显示出显著的关联.
- 与不使用相比,较高的SSRI剂量与严重痴呆,骨折和全因死亡率的风险增加有关.
结论:
- 目前在痴呆症患者中使用抗抑郁药与更快的认知衰退率有关.
- 较高的SSRI剂量与严重痴呆,骨折和全因死亡率的风险增加有关.
- 仔细监测抗抑郁药的风险和益处对于痴呆症患者至关重要.
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