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首页> 外文期刊>Drugs and aging >Drug-induced cognitive impairment in the elderly.
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Drug-induced cognitive impairment in the elderly.

机译：药物引起的老年人认知障碍。

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Elderly people are more likely than younger patients to develop cognitive impairment as a result of taking medications. This reflects age- and disease-associated changes in brain neurochemistry and drug handling. Delirium (acute confusional state) is the cognitive disturbance most clearly associated with drug toxicity, but dementia has also been reported. The aetiology of cognitive impairment is commonly multifactorial, and it may be difficult to firmly establish a causal role for an individual medication. In studies of elderly hospital patients, drugs have been reported as the cause of delirium in 11 to 30% of cases. Medication toxicity occurs in 2 to 12% of patients presenting with suspected dementia. In some cases CNS toxicity occurs in a dose-dependent manner, often as a result of interference with neurotransmitter function. Drug-induced delirium can also occur as an idiosyncratic complication. Finally, delirium may occur secondary to iatrogenic complications of drug use. Almost any drug can cause delirium, especially in a vulnerable patient. Impaired cholinergic neurotransmission has been implicated in the pathogenesis of delirium and of Alzheimer's disease. Anticholinergic medications are important causes of acute and chronic confusional states. Nevertheless, polypharmacy with anticholinergic compounds is common, especially in nursing home residents. Recent studies have suggested that the total burden of anticholinergic drugs may determine development of delirium rather than any single agent. Also, anticholinergic effects have been identified in many drugs other than those classically thought of as having major anticholinergic effects. Psychoactive drugs are important causes of delirium. Narcotic agents are among the most important causes of delirium in postoperative patients. Long-acting benzodiazepines are the commonest drugs to cause or exacerbate dementia. Delirium was a major complication of treatment with tricyclic antidepressants but seems less common with newer agents. Anticonvulsants can cause delirium and dementia. Drug-induced confusion with nonpsychoactive drugs is often idiosyncratic in nature, and the diagnosis is easily missed unless clinicians maintain a high index of suspicion. Histamine H2 receptor antagonists, cardiac medications such as digoxin and beta-blockers, corticosteroids, non-steroidal anti-inflammatory agents and antibiotics can all cause acute, and, less commonly, chronic confusion. Drug-induced confusion can be prevented by avoiding polypharmacy and adhering to the saying 'start low and go slow'. Special care is needed when prescribing for people with cognitive impairment. Early diagnosis of drug-induced confusion, and withdrawal of the offending agent or agents is essential.
机译：老年人比年轻人更容易因服用药物而出现认知障碍。这反映了与年龄和疾病相关的大脑神经化学和药物处理变化。妄（急性精神错乱状态）是与药物毒性最明显相关的认知障碍，但也有痴呆症的报道。认知障碍的病因通常是多因素的，因此可能难以确定每种药物的因果关系。在对老年医院患者的研究中，据报道在11％至30％的病例中药物是导致ir妄的原因。在可疑痴呆患者中，有2至12％的患者发生药物毒性。在某些情况下，中枢神经系统毒性通常是由于干扰神经递质功能而以剂量依赖性方式发生。药物引起的del妄也可作为特发性并发症发生。最后，del妄可能继发于药物使用的医源性并发症。几乎所有药物都可能引起ir妄，尤其是在弱势患者中。胆碱能神经传递受损与of妄和阿尔茨海默氏病的发病机理有关。抗胆碱能药物是急性和慢性混乱状态的重要原因。尽管如此，含抗胆碱能化合物的多药房还是很常见的，尤其是在疗养院居民中。最近的研究表明，抗胆碱能药物的总负担可能决定ir妄的发展，而不是任何单一药物。此外，除了传统上认为具有主要抗胆碱作用的那些药物以外，在许多药物中也已经确定了抗胆碱作用。精神药物是引起ir妄的重要原因。麻醉剂是术后患者del妄的最重要原因。长效苯二氮卓类药物是引起或加剧痴呆的最常见药物。 r妄是三环类抗抑郁药治疗的主要并发症，但在新型药物中似乎较少见。抗惊厥药可能引起del妄和痴呆。药物引起的与非精神活性药物的混淆在本质上通常是特异的，除非临床医生保持高度怀疑的态度，否则很容易错过诊断。组胺H2受体拮抗剂，地高辛和β-受体阻滞剂等心脏药物，皮质类固醇，非类固醇抗炎药和抗生素都可能引起急性，并且较不常见的是引起慢性混淆。可以避免多药店并坚持“从低而慢”的说法，以防止药物引起的混乱。处方有认知障碍的人时需要特别注意。早期诊断药物引起的混乱，以及撤消一种或多种违规药物至关重要。

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