Kathrin Heser1, Tobias Luck2, Susanne Röhr3, Birgitt Wiese4, Hanna Kaduszkiewicz5, Anke Oey4, Horst Bickel6, Edelgard Mösch6, Siegfried Weyerer7, Jochen Werle7, Christian Brettschneider8, Hans-Helmut König8, Angela Fuchs9, Michael Pentzek9, Hendrik van den Bussche10, Martin Scherer10, Wolfgang Maier11, Steffi G Riedel-Heller2, Michael Wagner11. 1. Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany. Electronic address: Kathrin.Heser@ukbonn.de. 2. Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany. 3. Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany; LIFE - Leipzig Research Center for Civilization Diseases, University of Leipzig, Leipzig, Germany. 4. Working Group Medical Statistics and IT Infrastructure, Institute of General Practice, Hannover Medical School, Hannover, Germany. 5. Institute of General Practice, Medical Faculty, Kiel University, Kiel, Germany. 6. Department of Psychiatry, Technical University Munich, Munich, Germany. 7. Central Institute of Mental Health, Medical Faculty Mannheim/Heidelberg University, Mannheim, Germany. 8. Department of Health Economics and Health Services Research, Hamburg Center for Health Economics, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 9. Institute of General Practice (ifam), Medical Faculty, Heinrich-Heine University Düsseldorf, Düsseldorf, Germany. 10. Department of Primary Medical Care, University Medical Center Hamburg-Eppendorf, Hamburg, Germany. 11. Department of Psychiatry and Psychotherapy, University of Bonn, Bonn, Germany; DZNE, Center for Neurodegenerative Diseases, Bonn, Germany.
Abstract
BACKGROUND: Potentially inappropriate medication (PIM) is associated with an increased risk for detrimental health outcomes in elderly patients. Some antidepressant drugs are considered as PIM, but previous research on the association between antidepressants and subsequent dementia has been inconclusive. Therefore, we investigated whether the intake of antidepressants, particularly of those considered as PIM according to the Priscus list, would predict incident dementia. METHODS: We used data of a prospective cohort study of non-demented primary care patients (n = 3239, mean age = 79.62) to compute Cox proportional hazards models. The risk for subsequent dementia was estimated over eight follow-ups up to 12 years depending on antidepressant intake and covariates. RESULTS: The intake of antidepressants was associated with an increased risk for subsequent dementia (HR = 1.53, 95% CI: 1.16-2.02, p = .003; age-, sex-, education-adjusted). PIM antidepressants (HR = 1.49, 95% CI: 1.06-2.10, p = .021), but not other antidepressants (HR = 1.04, 95% CI: 0.66-1.66, p = .863), were associated with an increased risk for subsequent dementia (in age-, sex-, education-, and depressive symptoms adjusted models). Significant associations disappeared after global cognition at baseline was controlled for. LIMITATIONS: Methodological limitations such as selection biases and self-reported drug assessments might have influenced the results. CONCLUSIONS: Only antidepressants considered as PIM were associated with an increased subsequent dementia risk. Anticholinergic effects might explain this relationship. The association disappeared after the statistical control for global cognition at baseline. Nonetheless, physicians should avoid the prescription of PIM antidepressants in elderly patients whenever possible.
BACKGROUND: Potentially inappropriate medication (PIM) is associated with an increased risk for detrimental health outcomes in elderly patients. Some antidepressant drugs are considered as PIM, but previous research on the association between antidepressants and subsequent dementia has been inconclusive. Therefore, we investigated whether the intake of antidepressants, particularly of those considered as PIM according to the Priscus list, would predict incident dementia. METHODS: We used data of a prospective cohort study of non-demented primary care patients (n = 3239, mean age = 79.62) to compute Cox proportional hazards models. The risk for subsequent dementia was estimated over eight follow-ups up to 12 years depending on antidepressant intake and covariates. RESULTS: The intake of antidepressants was associated with an increased risk for subsequent dementia (HR = 1.53, 95% CI: 1.16-2.02, p = .003; age-, sex-, education-adjusted). PIM antidepressants (HR = 1.49, 95% CI: 1.06-2.10, p = .021), but not other antidepressants (HR = 1.04, 95% CI: 0.66-1.66, p = .863), were associated with an increased risk for subsequent dementia (in age-, sex-, education-, and depressive symptoms adjusted models). Significant associations disappeared after global cognition at baseline was controlled for. LIMITATIONS: Methodological limitations such as selection biases and self-reported drug assessments might have influenced the results. CONCLUSIONS: Only antidepressants considered as PIM were associated with an increased subsequent dementia risk. Anticholinergic effects might explain this relationship. The association disappeared after the statistical control for global cognition at baseline. Nonetheless, physicians should avoid the prescription of PIM antidepressants in elderly patients whenever possible.
Authors: Andrea Zülke; Tobias Luck; Alexander Pabst; Wolfgang Hoffmann; Jochen René Thyrian; Jochen Gensichen; Hanna Kaduszkiewicz; Hans-Helmut König; Walter E Haefeli; David Czock; Birgitt Wiese; Thomas Frese; Susanne Röhr; Steffi G Riedel-Heller Journal: BMC Geriatr Date: 2019-08-01 Impact factor: 3.921