日本抗胆碱能风险量表与老年卒中后患者特定领域功能结局

文献信息

中文摘要

目的： 国际抗胆碱能负担量表可能无法完全反映各国特定的处方模式和药物可及性。尽管日本抗胆碱能风险量表（JARS）反映了日本临床实践，但其在卒中后患者中的预后相关性仍不明确。我们研究了JARS是否与老年卒中后患者在日常生活活动能力（ADL）、认知、吞咽、营养和肌力等方面的功能结局相关。
方法： 这项回顾性队列研究连续纳入了年龄≥65岁、接受卒中后康复的患者。入院时使用JARS评估抗胆碱能负担。主要结局为出院时的功能独立性评定（FIM）-运动评分。次要结局为出院时的FIM-认知评分、食物摄入水平量表、老年营养风险指数（GNRI）和握力。对总JARS进行多变量线性回归，并作为探索性分析对精神药物来源的JARS进行多变量线性回归，同时调整相关协变量。使用Benjamini-Hochberg错误发现率（FDR）程序对五个结局的p值进行校正。
结果： 在747例患者中（中位年龄80.0岁；51%为男性），484例（64.8%）的JARS评分≥1。总JARS与出院时FIM-运动评分（B=0.032，95% CI -0.799至0.862）、FIM-认知评分、FILS或握力无关。然而，在主分析中，较高的总JARS与出院时GNRI呈负相关（B=-0.603；95% CI，-1.061至-0.146；FDR校正后p=0.049），尽管在改良JARS敏感性分析中该关联未保持统计学显著性（B=-0.666；95% CI，-1.179至-0.154；FDR校正后p=0.055）。精神药物来源的JARS与较低的FIM-认知评分相关（B=-0.800；95% CI，-1.318至-0.282；FDR校正后p=0.013），但在FDR校正后与其他结局无关。
结论： JARS与出院时ADL、吞咽或肌力无关。在主分析中观察到其与营养风险存在适度关联，但由于在改良JARS敏感性分析中未保持统计学显著性，因此应谨慎解释这一发现。精神药物来源的JARS与认知水平相关。这些发现支持对抗胆碱能负担进行领域特异性和药物类别特异性的解读。

英文摘要

AIM: International anticholinergic burden scales may incompletely capture country-specific prescribing patterns and drug availability. Although the Japanese Anticholinergic Risk Scale (JARS) reflects Japanese clinical practice, its prognostic relevance in poststroke patients remains unclear. We examined whether JARS was associated with functional outcomes across activities of daily living (ADL), cognition, swallowing, nutrition, and muscle strength in older patients after stroke.
METHODS: This retrospective cohort study enrolled consecutive patients aged ≥ 65 years undergoing poststroke rehabilitation. Anticholinergic burden was assessed using JARS at admission. The primary outcome was Functional Independence Measure (FIM)-motor at discharge. Secondary outcomes were FIM-cognitive, Food Intake Level Scale, Geriatric Nutritional Risk Index (GNRI), and handgrip strength at discharge. Multivariable linear regression was performed for total JARS and, as an exploratory analysis, psychotropic drug-derived JARS, with adjustment for relevant covariates. p-values were adjusted across the five outcomes using the Benjamini-Hochberg false discovery rate (FDR) procedure.
RESULTS: Among 747 patients (median age, 80.0 years; 51% men), 484 (64.8%) had a JARS score of ≥ 1. Total JARS was not associated with discharge FIM-motor score (B = 0.032, 95% CI -0.799 to 0.862), FIM-cognitive score, FILS, or handgrip strength. However, higher total JARS was negatively associated with GNRI at discharge in the primary analysis (B = -0.603; 95% CI, -1.061 to -0.146; FDR-adjusted p = 0.049) although this association did not remain statistically significant in the modified-JARS sensitivity analysis (B = -0.666; 95% CI, -1.179 to -0.154; FDR-adjusted p = 0.055). Psychotropic drug-derived JARS was associated with lower FIM-cognitive score (B = -0.800; 95% CI, -1.318 to -0.282; FDR-adjusted p = 0.013), but not with the other outcomes after FDR adjustment.
CONCLUSIONS: JARS was not associated with discharge ADL, swallowing, or muscle strength. A modest association with nutritional risk was observed in the primary analysis, although this finding should be interpreted cautiously because statistical significance was not retained in the modified-JARS sensitivity analysis. Psychotropic drug-derived JARS was associated with cognitive level. These findings support domain- and drug-class-specific interpretation of anticholinergic burden.