药源性认知障碍的致病药物及疾病风险评估研究进展

doi:10.19803/j.1672-8629.20260606

摘要/Abstract

摘要： 目的梳理各类可诱发药物性认知障碍的高危药物、致病机制、临床表现,对比主流抗胆碱负荷及老年不合理用药筛查量表,为临床用药风险筛查提供参考。方法汇总国内外药源性认知障碍相关指南、临床对照研究与回顾性分析文献,系统梳理抗胆碱能制剂、镇静催眠药、麻醉药物等损伤认知的作用机制;对比抗胆碱能认知负担（ACB）量表、比尔斯标准（Beers标准）、老年人潜在不适当处方筛查工具/处方精简筛查工具（STOPP/START）等评估工具的适用范围、优势与局限。结果抗胆碱能药物导致的认知障碍最为突出,多重用药会产生抗胆碱能效应累加;联合用药、患者年龄等均为认知损伤关键影响因素;ACB量表与临床结果更相关。结论多类常用药物均可诱发认知障碍,老年多重用药人群为核心防控对象;临床可选用 ACB 量表量化抗胆碱负荷,结合Beers标准、STOPP/START完成多品种高危药物筛查,及时识别和干预药物性认知障碍发生风险。

关键词: 药源性认知障碍, 抗胆碱能药, 危险因素, 风险评估, 药品不良反应

Abstract: Objective To identify high-risk drugs that can induce cognitive impairment, summarize their pathological mechanisms and clinical manifestations, and compare mainstream scales for the anticholinergic burden and inappropriate medication screening in elders so as to provide references for clinical screening of risks of medication. Methods Related guidelines, controlled clinical trials, and retrospective studies on drug-induced cognitive impairment published globally were retrieved. The mechanisms by which anticholinergic agents, sedative-hypnotics, anesthetics, and other medicines impaired cognitive function were summarized. The applicability, strengths and weaknesses of assessment tools, including the Anticholinergic Cognitive Burden (ACB) scale, the Beers Criteria, the STOPP/START criteria, and the Mini-Mental State Examination (MMSE), were compared. Results Anticholinergic agents were most likely to trigger cognitive impairment while polypharmacy could cause cumulative anticholinergic effects. Polypharmacy and patients' age were key contributors to cognitive impairment. The ACB scale was more correlated with clinical outcomes than other tools. Conclusion A range of commonly-used drugs can induce cognitive impairment, and elderly patients with polypharmacy are the most vulnerable. Clinicians are advised to adopt the ACB scale to quantify the anticholinergic burden, combine it with the Beers Criteria and STOPP/START to screen a variety of high-risk drugs, and intervene quickly to reduce the risks of drug-induced cognitive impairment.

Key words: Drug-Induced Cognitive Impairment (DICI), Anticholinergic Drugs, Risk Factors, Risk Assessment, Adverse Drug Reaction

中图分类号:

R994.11

向群, 傅大莉. 药源性认知障碍的致病药物及疾病风险评估研究进展[J]. 中国药物警戒, 2026, 23(9): 1075-1080.

Xiang Qun, Fu Dali. Research progress in pathogenic drugs related to drug-induced cognitive impairment and disease risk assessment[J]. Chinese Journal of Pharmacovigilance, 2026, 23(9): 1075-1080.

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