TY - JOUR
T1 - Dose-responsive effect of psychotropic drug use and subsequent dementia
T2 - A nationwide propensity score matched case-control study in Taiwan
AU - Hsiao, Fei Yuan
AU - Peng, Li Ning
AU - Lin, Ming Hsien
AU - Chen, Liang Kung
N1 - Funding Information:
The authors thank the National Health Insurance Association and National Health Research Institutes for making available the databases for this study. The content of this article, however, in no way represents any official position of the National Health Insurance Association or National Health Research Institutes. The author had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
PY - 2014/7
Y1 - 2014/7
N2 - Objective: To test the hypothesis that the load of psychotropic agents was associated with subsequent dementia occurrence by a nationwide database. Design: Propensity score matched case-control study. Setting: National Health Insurance Research database. Participants: A total of 32,649 older people with dementia and 32,649 matched dementia-free older people. Measurements: Use of psychotropic drugs (anxiolytics, antipsychotics, hypnotics, and antidepressants), defined daily dose (DDD) of psychotropic drugs, diagnosis of dementia, and propensity score. Intervention: None. Results: Compared with nonusers, ever use of psychotropic agents was associated with higher odds of subsequent dementia [adjusted odds ratio (OR): 3.73; 95% confidence interval (CI) (3.59-3.88)]. Significantly, the association was stronger with longer term exposure to psychotropic agents. The ORs at exposures of <90 days, 90-180 days, and >180 days, were 3.14 (95% CI 3.01-3.28); 5.48 (5.07-5.93); and 7.54 (6.73-8.44), respectively. A similar and stronger association was identified when cumulative dose was used to measure the exposure of psychotropic agents [<90 DDDs, 3.40 (95% CI 3.26-3.54); 90-180 DDDs 6.38 (5.76-7.07), and >180 DDDs, 7.35 (6.29-8.58)]. Conclusions: We found that a higher burden of psychotropic agents was strongly associated with a higher odds of subsequent dementia. Careful monitoring of any elderly who is prescribed or uptitrated psychotropic agents is highly recommended, especially those who combine use of more than one agent. Furthermore, providing timely assessment for cognitive function for older patients consuming psychotropic drugs is of great importance.
AB - Objective: To test the hypothesis that the load of psychotropic agents was associated with subsequent dementia occurrence by a nationwide database. Design: Propensity score matched case-control study. Setting: National Health Insurance Research database. Participants: A total of 32,649 older people with dementia and 32,649 matched dementia-free older people. Measurements: Use of psychotropic drugs (anxiolytics, antipsychotics, hypnotics, and antidepressants), defined daily dose (DDD) of psychotropic drugs, diagnosis of dementia, and propensity score. Intervention: None. Results: Compared with nonusers, ever use of psychotropic agents was associated with higher odds of subsequent dementia [adjusted odds ratio (OR): 3.73; 95% confidence interval (CI) (3.59-3.88)]. Significantly, the association was stronger with longer term exposure to psychotropic agents. The ORs at exposures of <90 days, 90-180 days, and >180 days, were 3.14 (95% CI 3.01-3.28); 5.48 (5.07-5.93); and 7.54 (6.73-8.44), respectively. A similar and stronger association was identified when cumulative dose was used to measure the exposure of psychotropic agents [<90 DDDs, 3.40 (95% CI 3.26-3.54); 90-180 DDDs 6.38 (5.76-7.07), and >180 DDDs, 7.35 (6.29-8.58)]. Conclusions: We found that a higher burden of psychotropic agents was strongly associated with a higher odds of subsequent dementia. Careful monitoring of any elderly who is prescribed or uptitrated psychotropic agents is highly recommended, especially those who combine use of more than one agent. Furthermore, providing timely assessment for cognitive function for older patients consuming psychotropic drugs is of great importance.
KW - Case-control study
KW - Cognition
KW - Dementia
KW - National health insurance database
KW - Psychotropic agents
UR - http://www.scopus.com/inward/record.url?scp=84903196734&partnerID=8YFLogxK
U2 - 10.1016/j.jamda.2014.02.009
DO - 10.1016/j.jamda.2014.02.009
M3 - Article
C2 - 24685407
AN - SCOPUS:84903196734
SN - 1525-8610
VL - 15
SP - 509
EP - 513
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 7
ER -