Table3_Exposure to anticholinergic and sedative medication is associated with impaired functioning in older people with vertigo, dizziness and balance disorders—Results from the longitudinal multicenter study MobilE-TRA.docx

Introduction: Anticholinergic and sedative medication is prescribed for various conditions in older patients. While the general association between anticholinergic and sedative medication and impaired functioning is well established, its specific role in older individuals with vertigo, dizziness, and balance disorders (VDB) is still incompletely understood. The objective of this study was to investigate, whether an exposure to anticholinergic and sedative medication is associated with lower generic and lower vertigo-specific functioning in older patients with VDB.
Methods: Data originates from the longitudinal multicenter study MobilE-TRA with two follow-ups, conducted from 2017 to 2019 in two German federal states. Exposure to anticholinergic and sedative medication was quantified using the drug burden index (DBI). Generic functioning was assessed by the Health Assessment Questionnaire Disability Index, appraising the amount of difficulties in performing activities of daily living (ADL). Vertigo-specific functioning was measured using the Vestibular Activities and Participation (VAP) questionnaire, assessing patient-reported functioning regarding activities of daily living that are difficult to perform because of their propensity to provoke VDB (Scale 1) as well as immediate consequences of VDB on activities and participation related to mobility (Scale 2). Longitudinal linear mixed models were applied to assess the association of exposure to anticholinergic and sedative medication at baseline and the level of generic and vertigo-specific functioning status over time.
Results: An overall of 19 (7 from Bavaria) primary care physicians (mean age = 54 years, 29% female) recruited 158 (59% from Bavaria) patients with VDB (median age = 78 years, 70% female). Anticholinergic and sedative medication at baseline was present in 56 (35%) patients. An exposure to anticholinergic and sedative medication at baseline was significantly associated with lower generic functioning [Beta = 0.40, 95%-CI (0.18; 0.61)] and lower vertigo-specific functioning [VAP Scale 1: Beta = 2.47, 95%-CI (0.92; 4.02)], and VAP Scale 2: Beta = 3.74, 95%-CI [2.23; 5.24]).
Conclusion: Our results highlight the importance of a close monitoring of anticholinergic and sedative medication use in older patients with VDB. When feasible, anticholinergic and sedative medication should be replaced by equivalent alternative therapies in order to potentially reduce the burden of VDB.

引言：抗胆碱能镇静药物（Anticholinergic and Sedative Medication）常用于老年患者的多种病症治疗。尽管抗胆碱能镇静药物与功能受损之间的普遍关联已得到广泛证实，但此类药物在合并眩晕、头晕及平衡障碍（Vertigo, Dizziness, and Balance Disorders, VDB）的老年患者中的具体作用仍未完全阐明。本研究旨在探讨抗胆碱能镇静药物暴露是否与VDB老年患者的总体功能较差及眩晕特异性功能较差相关。
方法：本研究数据来源于2017至2019年在德国两个联邦州开展的、含两次随访的纵向多中心研究MobilE-TRA。采用药物负担指数（Drug Burden Index, DBI）对抗胆碱能镇静药物的暴露量进行量化。通过健康评估问卷残疾指数（Health Assessment Questionnaire Disability Index）评估总体功能，该量表用于评价患者完成日常生活活动（Activities of Daily Living, ADL）时的困难程度。采用前庭活动与参与量表（Vestibular Activities and Participation, VAP）评估眩晕特异性功能，该问卷用于评估患者自我报告的、因易诱发VDB而难以完成的日常生活活动相关功能（量表1），以及VDB对与活动能力相关的活动及社会参与的即时影响（量表2）。采用纵向线性混合模型，评估基线时抗胆碱能镇静药物暴露与随时间变化的总体功能及眩晕特异性功能水平之间的关联。
结果：共计19名全科基层医师（其中7名来自巴伐利亚州，平均年龄54岁，女性占比29%）招募了158名VDB患者（其中59%来自巴伐利亚州，中位年龄78岁，女性占比70%）。基线时有56例（35%）患者存在抗胆碱能镇静药物暴露。基线时抗胆碱能镇静药物暴露与较差的总体功能[β=0.40，95%置信区间（CI）：0.18~0.61]及较差的眩晕特异性功能[VAP量表1：β=2.47，95%CI：0.92~4.02；VAP量表2：β=3.74，95%CI：2.23~5.24]显著相关。
结论：本研究结果强调，对VDB老年患者的抗胆碱能镇静药物使用情况进行密切监测具有重要意义。在可行的情况下，应使用等效替代疗法替换抗胆碱能镇静药物，以潜在减轻VDB带来的疾病负担。