Pei-Shan Tsai1, I-Chao Liu2, Chen-Huan Chiu3, Chun-Jen Huang4, Mei-Yeh Wang5. 1. School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Sleep Science Center, Taipei Medical University Hospital, Taipei, Taiwan. 2. Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan. 3. Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of General Psychiatry, Taipei City Psychiatric Center, Taipei, Taiwan. 4. Department of Anesthesiology, Taipei Tzu Chi Hospital, 289, Jian Gou Road, Sindian District, New Taipei City 23142, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: huangcj1112@gmail.com. 5. Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, 112, Minzu Road, Sindian District, New Taipei City 23143, Taiwan. Electronic address: mywang@ctcn.edu.tw.
Abstract
BACKGROUND: Valproic acid (VPA) is widely used for treating patients with bipolar disorder; however, it has adverse effects on cognitive function. This study investigated the effect of VPA on the risk of dementia in patients with bipolar disorder. METHODS: We analyzed data from Taiwan's Longitudinal Health Insurance Database 2010. Patients with bipolar disorder who were prescribed VPA for 28 days or at least once per month for 3 consecutive months after the index date were classified as the VPA-treated group, whereas those who did not receive VPA were classified as the VPA-untreated group. Both groups were tracked until the end of 2013 or until loss to follow-up to identify new-onset dementia events. Multivariable Cox proportional hazards models were used to estimate the hazard ratio (HR) of subsequent dementia associated with VPA treatment after adjustment for confounding variables. RESULTS: The study comprised 5158 patients with bipolar disorder. The multivariable-adjusted HR for newly diagnosed dementia was 1.73 (95% confidence interval [CI], 1.24-2.41, P=0.001) for the VPA-treated group compared with the VPA-untreated group after adjustment for potential confounders. The VPA-treated group had a higher risk than did the VPA-untreated group after propensity score adjustment (HR=1.95, 95% CI=1.42-2.67, P<0.001). LIMITATION: Certain variables that may affect the incidence of dementia were unavailable in the claims database and thus could not be considered. CONCLUSION: Treating bipolar disorder with VPA increases the risk of dementia by 73-95%.
BACKGROUND:Valproic acid (VPA) is widely used for treating patients with bipolar disorder; however, it has adverse effects on cognitive function. This study investigated the effect of VPA on the risk of dementia in patients with bipolar disorder. METHODS: We analyzed data from Taiwan's Longitudinal Health Insurance Database 2010. Patients with bipolar disorder who were prescribed VPA for 28 days or at least once per month for 3 consecutive months after the index date were classified as the VPA-treated group, whereas those who did not receive VPA were classified as the VPA-untreated group. Both groups were tracked until the end of 2013 or until loss to follow-up to identify new-onset dementia events. Multivariable Cox proportional hazards models were used to estimate the hazard ratio (HR) of subsequent dementia associated with VPA treatment after adjustment for confounding variables. RESULTS: The study comprised 5158 patients with bipolar disorder. The multivariable-adjusted HR for newly diagnosed dementia was 1.73 (95% confidence interval [CI], 1.24-2.41, P=0.001) for the VPA-treated group compared with the VPA-untreated group after adjustment for potential confounders. The VPA-treated group had a higher risk than did the VPA-untreated group after propensity score adjustment (HR=1.95, 95% CI=1.42-2.67, P<0.001). LIMITATION: Certain variables that may affect the incidence of dementia were unavailable in the claims database and thus could not be considered. CONCLUSION: Treating bipolar disorder with VPA increases the risk of dementia by 73-95%.
Authors: Yun Freudenberg-Hua; Alexander Makhnevich; Wentian Li; Yan Liu; Michael Qiu; Allison Marziliano; Maria Carney; Blaine Greenwald; John M Kane; Michael Diefenbach; Edith Burns; Jeremy Koppel; Liron Sinvani Journal: Front Med (Lausanne) Date: 2022-03-18