Profil Penggunaan Obat dengan Sifat Antikolinergik dan Korelasinya terhadap Fungsi Kognitif Pasien Lanjut Usia

Pradhani Dhaneswari

doi:10.37287/jppp.v6i4.4463

Pradhani Dhaneswari

DOI: https://doi.org/10.37287/jppp.v6i4.4463

Keywords: antikolinergik, fungsu kognitif, lanjut usia

Abstract

Perubahan fisiologis pada lansia dapat memengaruhi respon pengobatan, sehingga berpotensi muncul efek samping dari penggunaan obat. Dalam hal ini, obat antikolinergik diketahui berdampak pada fungsi kognitif, terutama pada pasien lansia. Penelitian ini dilakukan untuk mengetahui korelasi tingkat beban antikolinergik terhadap status fungsi kognitif pada pasien lansia yang menjalani perawatan rawat jalan. Penelitian ini merupakan studi deskriptif non-eksperimental dengan metode cross sectional pada pasien lansia (≥60 tahun) yang menjalani perawatan di Poliklinik Rawat Jalan Penyakit Dalam dan Geriatri RSUP Dr. Sardjito Data profil pasien dan profil penggunaan obat didapatkan dari wawancara dan pengambilan data rekam medis. Penentuan tingkat beban obat antikolinergik menggunakan Anticholinergic Drugs Scale (ADS) dan penentuan status fungsi kognitif menggunakan Mini-Mental State Examination (MMSE). Korelasi antara variabel bebas (variabel utama dan variabel perancu) dengan variable terikat (status fungsi kognitif) didapatkan dengan menggunakan analisis multivariat regresi linier. Prevalensi penggunaan antikolinergik dari 102 pasien adalah 56,9% (n=58). Hasil regresi linier multivariat menunjukkan bahwa tingkat beban antikolinergik memiliki hubungan signifikan terhadap status fungsi kognitif pasien (p < 0,005; p = 0,013) dengan nilai R = -0,226 (95% Confidence Interval, CI: -0,968 - (- 0,118)). Peningkatan beban antikolinergik memiliki korelasi yang signifikan dengan status fungsi kognitif pada pasien lansia.

References

Alley, D., Suthers, K., & Crimmins, E. (2007). Education and Cognitive Decline in Older Americans: Results From the AHEAD Sample. Research on Aging, 29(1), 73–94. https://doi.org/10.1177/0164027506294245

Andre, L., Gallini, A., Montastruc, F., Coley, N., Montastruc, J.-L., Vellas, B., Andrieu, S., & Gardette, V. (2019). Anticholinergic exposure and cognitive decline in older adults: effect of anticholinergic exposure definitions in a 3-year analysis of the multidomain Alzheimer preventive trial (MAPT) study. British Journal of Clinical Pharmacology, 85(1), 71–99. https://doi.org/10.1111/bcp.13734

Ang, M. S., Abdul Rashid, N. A., Lam, M., Rapisarda, A., Kraus, M., Keefe, R. S. E., & Lee, J. (2017). The Impact of Medication Anticholinergic Burden on Cognitive Performance in People With Schizophrenia. Journal of Clinical Psychopharmacology, 37(6), 651–656. https://doi.org/10.1097/JCP.0000000000000790

Brito, D. V. C., Esteves, F., Rajado, A. T., Silva, N., Andrade, R., Apolónio, J., Calado, S., Faleiro, L., Matos, C., Marques, N., Marreiros, A., Nzwalo, H., Pais, S., Palmeirim, I., Roberto, V., Simão, S., Joaquim, N., Miranda, R., Pêgas, A., … Consortium, A. score. (2023). Assessing cognitive decline in the aging brain: lessons from rodent and human studies. Npj Aging, 9(1), 23. https://doi.org/10.1038/s41514-023-00120-6

Direktorat Statistik Kesejahteraan Rakyat. (2023). Statistik Lanjut Usia 2023 (D. S. K. Rakyat (ed.); 1st ed., Vol. 20, Issue 1). Badan Pusat Statistik.

Fletcher, J., Topping, M., Zheng, F., & Lu, Q. (2021). The effects of education on cognition in older age: Evidence from genotyped Siblings. Social Science & Medicine (1982), 280, 114044. https://doi.org/10.1016/j.socscimed.2021.114044

Fogel, S. M., Albouy, G., Vien, C., Popovicci, R., King, B. R., Hoge, R., Jbabdi, S., Benali, H., Karni, A., Maquet, P., Carrier, J., & Doyon, J. (2014). fMRI and sleep correlates of the age-related impairment in motor memory consolidation. Human Brain Mapping, 35(8), 3625–3645. https://doi.org/10.1002/hbm.22426

Godbole, S., Godbole, G., & Vaidya, S. (2016). Influence of education on cognitive function in the elderly population of Pune city, Maharashtra, India. International Journal of Research in Medical Sciences, 4(9 SE-Original Research Articles), 4119–4122. https://doi.org/10.18203/2320-6012.ijrms20162945

Gray, S. L., Anderson, M. L., Dublin, S., Hanlon, J. T., Hubbard, R., Walker, R., Yu, O., Crane, P. K., & Larson, E. B. (2015). Cumulative use of strong anticholinergics and incident dementia: a prospective cohort study. JAMA Internal Medicine, 175(3), 401–407. https://doi.org/10.1001/jamainternmed.2014.7663

Haam, J., & Yakel, J. L. (2017). Cholinergic modulation of the hippocampal region and memory function. Journal of Neurochemistry, 142 Suppl(Suppl 2), 111–121. https://doi.org/10.1111/jnc.14052

Hachisu, M., Konishi, K., Hosoi, M., Tani, M., Tomioka, H., Kitajima, Y., Inamoto, A., Hirata, A., Koganemaru, T., Tomita, A., Akashi, N., & Hori, K. (2015). Serum Anticholinergic Activity as an Index of Anticholinergic Activity Load in Alzheimer’s Disease. Neuro-Degenerative Diseases, 15(3), 134–139. https://doi.org/10.1159/000381483

Jansen, M. G., Geerligs, L., Claassen, J. A. H. R., Overdorp, E. J., Brazil, I. A., Kessels, R. P. C., & Oosterman, J. M. (2021). Positive Effects of Education on Cognitive Functioning Depend on Clinical Status and Neuropathological Severity. Frontiers in Human Neuroscience, 15. https://www.frontiersin.org/journals/human-neuroscience/articles/10.3389/fnhum.2021.723728

Kersten, H., & Wyller, T. B. (2014). Anticholinergic drug burden in older people’s brain - how well is it measured? Basic & Clinical Pharmacology & Toxicology, 114(2), 151–159. https://doi.org/10.1111/bcpt.12140

Krüger, C., Schäfer, I., van den Bussche, H., Bickel, H., Fuchs, A., Gensichen, J., König, H.-H., Maier, W., Mergenthal, K., Riedel-Heller, S. G., Schön, G., Weyerer, S., Wiese, B., von Renteln-Kruse, W., Langebrake, C., & Scherer, M. (2021). Anticholinergic drug burden according to the anticholinergic drug scale and the German anticholinergic burden and their impact on cognitive function in multimorbid elderly German people: a multicentre observational study. BMJ Open, 11(3), e044230. https://doi.org/10.1136/bmjopen-2020-044230

López-Álvarez, J., Sevilla-Llewellyn-Jones, J., & Agüera-Ortiz, L. (2019). Anticholinergic Drugs in Geriatric Psychopharmacology. Frontiers in Neuroscience, 13(December), 1–15. https://doi.org/10.3389/fnins.2019.01309

López-Álvarez, J., Zea Sevilla, M. A., Agüera Ortiz, L., Fernández Blázquez, M. Á., Valentí Soler, M., & Martínez-Martín, P. (2015). Effect of anticholinergic drugs on cognitive impairment in the elderly. Revista de Psiquiatría y Salud Mental (English Edition), 8(1), 35–43. https://doi.org/10.1016/j.rpsmen.2015.03.001

Lövdén, M., Fratiglioni, L., Glymour, M. M., Lindenberger, U., & Tucker-Drob, E. M. (2020). Education and Cognitive Functioning Across the Life Span. Psychological Science in the Public Interest : A Journal of the American Psychological Society, 21(1), 6–41. https://doi.org/10.1177/1529100620920576

Ramanoël, S., Durteste, M., Bécu, M., Habas, C., & Arleo, A. (2020). Differential Brain Activity in Regions Linked to Visuospatial Processing During Landmark-Based Navigation in Young and Healthy Older Adults. Frontiers in Human Neuroscience, 14, 552111. https://doi.org/10.3389/fnhum.2020.552111

Sultzer, D. L., Lim, A. C., Gordon, H. L., Yarns, B. C., & Melrose, R. J. (2022). Cholinergic receptor binding in unimpaired older adults, mild cognitive impairment, and Alzheimer’s disease dementia. Alzheimer’s Research & Therapy, 14(1), 25. https://doi.org/10.1186/s13195-021-00954-w

Taylor-Rowan, M., Kraia, O., Kolliopoulou, C., Noel-Storr, A. H., Alharthi, A. A., Cross, A. J., Stewart, C., Myint, P. K., McCleery, J., & Quinn, T. J. (2022). Anticholinergic burden for prediction of cognitive decline or neuropsychiatric symptoms in older adults with mild cognitive impairment or dementia. The Cochrane Database of Systematic Reviews, 8(8), CD015196. https://doi.org/10.1002/14651858.CD015196.pub2

Varghese, S. S. R. D. (2023). Geriatric Evaluation and Treatment of Age-Related Cognitive Decline. Treasure Island (FL): StatPearls Publishing.

Walker, R., Belperio, I., Scott, J., Luszcz, M., Mazzucchelli, T., Evans, T., & Windsor, T. D. (2023). Older Adults’ Views on Characteristics of Groups to Support Engagement. Activities, Adaptation & Aging, 1–21. https://doi.org/10.1080/01924788.2023.2249722

Yuly Abdi Zainurridha, Nurcholisa Aulia Sakinah, A. A. A. (2021). Faktor-Faktor yang Mempengaruhi Kemampuan Kognitif Lansia Yuly Abdi Zainurridha. Jurnal Penelitian Kesehatan Suara Forikes, 12(3), 287–289.

Zahodne, L. B., Glymour, M. M., Sparks, C., Bontempo, D., Dixon, R. A., MacDonald, S. W. S., & Manly, J. J. (2011). Education does not slow cognitive decline with aging: 12-year evidence from the victoria longitudinal study. Journal of the International Neuropsychological Society : JINS, 17(6), 1039–1046. https://doi.org/10.1017/S1355617711001044.