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Archives of gerontology and geriatrics. 2025 Apr 3:134:105846. doi: 10.1016/j.archger.2025.105846 Q23.52024

Multiple chronic conditions and polypharmacy in cognitively unimpaired older adults are associated with subsequent cognitive decline: results from the national alzheimer's coordinating center data

来自国立阿尔茨海默病协调中心数据的多变量分析:慢性疾病和非认知障碍老年人多重用药与后续认知能力下降相关性研究 翻译改进

Chooza Moon  1, Meina Zhang  2, Boxiang Wang  3, Sue E Gardner  4, Joel C Geerling  5, Karin F Hoth  6

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作者单位

  • 1 University of Iowa College of Nursing, United States. Electronic address: chooza-moon@uiowa.edu.
  • 2 University of Iowa College of Nursing, United States. Electronic address: meina-zhang@uiowa.edu.
  • 3 University of Iowa College of Liberal Arts and Sciences, Department of Statistics and Actuarial Science, United States. Electronic address: boxiang-wang@uiowa.edu.
  • 4 University of Iowa College of Nursing, United States. Electronic address: sue-gardner@uiowa.edu.
  • 5 University of Iowa, Department of Neurology, United States; University of Iowa, Iowa Neuroscience Institute, United States. Electronic address: joel-geerling@uiowa.edu.
  • 6 University of Iowa, Iowa Neuroscience Institute, United States; University of Iowa College of Medicine, Department of Psychiatry, United States. Electronic address: karin-hoth@uiowa.edu.
  • DOI: 10.1016/j.archger.2025.105846 PMID: 40220663

    摘要 中英对照阅读

    Prior cross-sectional studies revealed that multiple chronic conditions (MCC) and polypharmacy are associated with cognitive impairment. The purpose of this study was to determine whether the number of chronic conditions and the number of medications are associated with longitudinal changes in cognition (memory, attention/working memory, semantic ability/language, processing speed, executive function). We analyzed data from 5671 individuals (age 71.4 ± 9.3, 68 % female) from the National Alzheimer's Coordinating Center database who were cognitively unimpaired at baseline and had 3 or more subsequent visits. 57 % had more than two chronic conditions, and 44 % were taking 5 or more medications at baseline. At baseline, we observed that individuals with MCC had lower memory, attention/working memory, semantic ability/language, processing speed, and executive function performance than those without MCC. Using mixed-effect modeling approaches, we found that having a higher number of chronic conditions was associated with greater decline in semantic ability/language and executive function, and having a higher number of medications was associated with greater decline in attention/working memory, semantic ability/language, and executive function. The findings suggest that healthcare professionals and service providers should be conscious of the fact that patients dealing with MCC and those on multiple medications are vulnerable and require careful monitoring. Future studies are warranted using more comprehensive multimorbidity data and advanced analytic approaches, and prospective, controlled trials are warranted to test whether managing MCC and reducing the number of unnecessary medications or certain medications can prevent decline.

    Keywords: Alzheimer's disease; Cognition; Multiple chronic conditions; Polypharmacy.

    Keywords:multiple chronic conditions; polypharmacy; cognitive decline

    先前的横断面研究揭示了多重慢性病(MCC)和多药治疗与认知障碍之间的关联。本研究旨在确定慢性疾病的数量和药物的数量是否与认知功能(记忆、注意力/工作记忆、语义能力/语言、处理速度、执行功能)的纵向变化有关。我们分析了来自国家阿尔茨海默病协调中心数据库中5671名个体的数据,这些人在基线时无认知障碍,并且至少有3次后续访问记录。其中57%的人在基线上有两个以上的慢性疾病,44%的人正在服用五种或更多的药物。在基线水平上,我们观察到具有多重慢性疾病的个体的记忆、注意力/工作记忆、语义能力/语言、处理速度和执行功能的表现低于没有多重慢性疾病的个体。使用混合效应模型方法,我们发现患有更多慢性疾病与语义能力/语言和执行功能的更大下降相关,而服用更多的药物则与注意力/工作记忆、语义能力/语言以及执行功能的更大下降相关。这些研究结果表明,医疗保健专业人员和服务提供者应该意识到那些患有MCC和正在使用多种药物的患者是脆弱且需要仔细监测的。未来的研究应采用更全面的多发病数据和先进的分析方法,并进行前瞻性对照试验以测试管理MCC和减少不必要的或特定药物的数量是否可以预防认知功能下降。

    关键词:阿尔茨海默病;认知;多重慢性疾病;多药治疗

    关键词:多重慢性病; 多种用药; 认知衰退

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    期刊名:Archives of gerontology and geriatrics

    缩写:ARCH GERONTOL GERIAT

    ISSN:0167-4943

    e-ISSN:1872-6976

    IF/分区:3.5/Q2

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    Multiple chronic conditions and polypharmacy in cognitively unimpaired older adults are associated with subsequent cognitive decline: results from the national alzheimer's coordinating center data