Anticholinergic and benzodiazepine medication use and risk of incident dementia: a UK cohort study

Abstract Background Studies suggest that anticholinergic medication or benzodiazepine use could increase dementia risk. We tested this hypothesis using data from a UK cohort study. Methods We used data from the baseline (Y0), 2-year (Y2) and 10-year (Y10) waves of the Medical Research Council Cognitive Function and Ageing Study. Participants without dementia at Y2 were included (n = 8216). Use of benzodiazepines (including nonbenzodiazepine Z-drugs), anticholinergics with score 3 (ACB3) and anticholinergics with score 1 or 2 (ACB12) according to the Anticholinergic Cognitive Burden scale were coded as ever use (use at Y0 or Y2), recurrent use (Y0 and Y2), new use (Y2, but not Y0) or discontinued use (Y0, but not Y2). The outcome was incident dementia by Y10. Incidence rate ratios (IRR) were estimated using Poisson regression adjusted for potential confounders. Pre-planned subgroup analyses were conducted by age, sex and Y2 Mini-Mental State Examination (MMSE) score. Results Dementia incidence was 9.3% (N = 220 cases) between Y2 and Y10. The adjusted IRRs (95%CI) of developing dementia were 1.06 (0.72, 1.60), 1.28 (0.82, 2.00) and 0.89 (0.68, 1.17) for benzodiazepines, ACB3 and ACB12 ever-users compared with non-users. For recurrent users the respective IRRs were 1.30 (0.79, 2.14), 1.68 (1.00, 2.82) and 0.95 (0.71, 1.28). ACB3 ever-use was associated with dementia among those with Y2 MMSE> 25 (IRR = 2.28 [1.32–3.92]), but not if Y2 MMSE≤25 (IRR = 0.94 [0.51–1.73]). Conclusions Neither benzodiazepines nor ACB12 medications were associated with dementia. Recurrent use of ACB3 anticholinergics was associated with dementia, particularly in those with good baseline cognitive function. The long-term prescribing of anticholinergics should be avoided in older people.

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A Cohort Study of Anticholinergic Medication Burden and Incident Dementia and Stroke in Older Adults

Journal of General Internal Medicine ◽

10.1007/s11606-020-06550-2 ◽

2021 ◽

Author(s):

Jessica E. Lockery ◽

◽

Jonathan C. Broder ◽

Joanne Ryan ◽

Ashley C. Stewart ◽

...

Keyword(s):

Older Adults ◽

Cohort Study ◽

Anticholinergic Medication ◽

Incident Dementia

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Alcohol consumption in later life and reaching longevity: the Netherlands Cohort Study

Age and Ageing ◽

10.1093/ageing/afaa003 ◽

2020 ◽

Vol 49 (3) ◽

pp. 395-402 ◽

Cited By ~ 3

Author(s):

Piet A van den Brandt ◽

Lloyd Brandts

Keyword(s):

Cohort Study ◽

The Netherlands ◽

Binge Drinking ◽

Alcohol Intake ◽

Cox Regression ◽

Later Life ◽

History Of ◽

Using Data ◽

Moderate Alcohol Intake ◽

Study Participants

Abstract Background whether light-to-moderate alcohol intake is related to reduced mortality remains a subject of intense research and controversy. There are very few studies available on alcohol and reaching longevity. Methods we investigated the relationship of alcohol drinking characteristics with the probability to reach 90 years of age. Analyses were conducted using data from the Netherlands Cohort Study. Participants born in 1916–1917 (n = 7,807) completed a questionnaire in 1986 (age 68–70 years) and were followed up for vital status until the age of 90 years (2006–07). Multivariable Cox regression analyses with fixed follow-up time were based on 5,479 participants with complete data to calculate risk ratios (RRs) of reaching longevity (age 90 years). Results we found statistically significant positive associations between baseline alcohol intake and the probability of reaching 90 years in both men and women. Overall, the highest probability of reaching 90 was found in those consuming 5– < 15 g/d alcohol, with RR = 1.36 (95% CI, 1.20–1.55) when compared with abstainers. The exposure-response relationship was significantly non-linear in women, but not in men. Wine intake was positively associated with longevity (notably in women), whereas liquor was positively associated with longevity in men and inversely in women. Binge drinking pointed towards an inverse relationship with longevity. Alcohol intake was associated with longevity in those without and with a history of selected diseases. Conclusions the highest probability of reaching 90 years was found for those drinking 5– < 15 g alcohol/day. Although not significant, the risk estimates also indicate to avoid binge drinking.

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116Dementia risk in individuals with lifetime major trauma and post-traumatic stress disorder (PTSD) symptoms

International Journal of Epidemiology ◽

10.1093/ije/dyab168.487 ◽

2021 ◽

Vol 50 (Supplement_1) ◽

Author(s):

Dinuli Nilaweera

Keyword(s):

Executive Function ◽

Cognitive Function ◽

Major Trauma ◽

Later Life ◽

Community Dwelling ◽

Ptsd Symptoms ◽

Consistent Finding ◽

Dementia Risk ◽

Incident Dementia ◽

Lifetime Trauma

Abstract Background Increasing evidence suggests that stress may be a risk factor for dementia, however further investigation is required particularly in community-dwelling individuals. This study investigated whether lifetime major trauma with and without re-experiencing of PTSD symptoms is associated with dementia risk. Methods Participants were 1,700 community-dwelling men and women enrolled in the ESPRIT study of later-life neuropsychiatric disorders. Lifetime major trauma and PTSD were assessed using Watson’s PTSD Inventory. Cognitive function was measured using tests of global cognition, visual memory, verbal fluency, psychomotor speed and executive function. Fourteen-year incident dementia was diagnosed according to DSM-IV criteria. The association between lifetime trauma and cognition, as well as incident dementia was determined by multivariate logistic regression and Cox-proportional hazards regression, respectively. Results An unexpected, yet consistent finding was the association between lifetime major trauma without re-experiencing symptoms, and better baseline cognition (global OR: 0.67 [95% CI: 0.52-0.87], executive function OR: 0.69 [95% CI: 0.51-0.93]). Furthermore, lifetime trauma without re-experiencing symptoms was associated with a decreased risk of dementia (HR: 0.63, 95% CI: 0.44-0.91), particularly for females (HR: 0.49, 95% CI: 0.29-0.80). Conclusions Lifetime major trauma without re-experiencing symptoms may be protective for later-life cognitive function and could reduce dementia risk, especially in females. The mechanisms and moderating factors underlying these association requires further investigation. Key messages This study presents novel findings, and suggests that in some instances, experiencing traumatic events may be beneficial in later-life health.

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Association Between Anemia and Dementia: A Nationwide, Populationbased Cohort Study in Taiwan

Current Alzheimer Research ◽

10.2174/1567205017666200317101516 ◽

2020 ◽

Vol 17 (2) ◽

pp. 196-204 ◽

Cited By ~ 2

Author(s):

Chien-Tai Hong ◽

Yi-Chen Hsieh ◽

Hung-Yi Liu ◽

Hung-Yi Chiou ◽

Li-Nien Chien

Keyword(s):

Cohort Study ◽

Positive Association ◽

Population Based ◽

Deficiency Anemia ◽

Research Database ◽

Newly Diagnosed ◽

Nervous Disease ◽

Subdistribution Hazard ◽

Dementia Risk ◽

Using Data

Background: In addition to the traditional risk predictors, whether anemia is an early biomarker of dementia, needs to be confirmed. Objective: This population-based cohort study aimed to investigate the dementia risk in patients with newly diagnosed anemia using data from the Taiwan National Health Insurance Research Database. Methods: All newly diagnosed anemia patients (n = 26,343) with no history of stroke hospitalization, central nervous disease other than dementia, psychiatric disorders, traumatic brain injury, major operations, or blood loss diseases, were enrolled. A group of non-anemic controls, 1:4 matched with anemic patients on the basis of demographics and comorbidities, was also included. A competing risk analysis was used to evaluate the dementia risk in anemic patients compared to that of their matched controls. Results: The adjusted subdistribution hazard ratio (SHR) of dementia risk in anemic patients was 1.14 (95% confidence interval [CI]: 1.08~1.21, p<0.001). Patients with iron supplements tended to exhibit a lower dementia risk (adjusted SHR: 0.84; 95% CI: 0.75~0.94, p=0.002) compared to patients without iron supplement. A subgroup analysis showed that a positive association between dementia and anemia existed in females, those aged 70 years and older, and patients without hypertension, diabetes, or hyperlipidemia. Conclusion: The present population-based cohort study identified that newly diagnosed anemia is a risk factor for dementia and also that iron supplementation was able to reduce the risk of dementia in people with iron deficiency anemia.

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[P2-544]: CONCOMITANT USE OF ANTICHOLINERGIC MEDICATION ATTENUATES BENEFITS OF CHOLINESTERASE INHIBITORS IN ALZHEIMER's DISEASE: A LARGE COHORT STUDY OF SURVIVAL AND COGNITIVE FUNCTION

Alzheimer s & Dementia ◽

10.1016/j.jalz.2017.06.1202 ◽

2017 ◽

Vol 13 (7S_Part_17) ◽

pp. P851-P851

Author(s):

Christoph Mueller ◽

Brendon Stubbs ◽

Shriya Banerji ◽

Robert Stewart ◽

Gayan Perera

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Cohort Study ◽

Cognitive Function ◽

Cholinesterase Inhibitors ◽

Large Cohort ◽

Anticholinergic Medication ◽

Large Cohort Study

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Body size, non-occupational physical activity and the chance of reaching longevity in men and women: findings from the Netherlands Cohort Study

Journal of Epidemiology & Community Health ◽

10.1136/jech-2018-211410 ◽

2019 ◽

Vol 73 (3) ◽

pp. 239-249 ◽

Cited By ~ 5

Author(s):

Lloyd Brandts ◽

Piet A van den Brandt

Keyword(s):

Physical Activity ◽

Cohort Study ◽

Body Size ◽

The Netherlands ◽

Cox Regression ◽

Occupational Physical Activity ◽

Vital Status ◽

Human Lifespan ◽

Using Data ◽

Study Participants

IntroductionThe rising number of obese and/or physically inactive individuals might negatively impact human lifespan. This study assessed the association between height, body mass index (BMI) and non-occupational physical activity and the likelihood of reaching 90 years of age, in both sexes separately.MethodsAnalyses were conducted using data from the Netherlands Cohort Study. Participants born in 1916–1917 (n=7807) completed a questionnaire in 1986 (at age 68–70 years) and were followed up for vital status information until the age of 90 years (2006–2007). Cox regression analyses were based on 5479 participants with complete data to calculate risk ratios (RRs) of reaching longevity (age 90 years).ResultsIn women, we observed significant associations between reaching longevity and height (RR: 1.05 per 5 cm increment; 95% CI 1.00 to 1.09), BMI at baseline (≥30vs18.5–<25 kg/m2; RR: 0.68; 95% CI 0.54 to 0.86) and BMI change since age 20 years (≥8vs0–<4 kg/m2; RR: 0.81; 95% CI 0.66 to 0.98). In men, height and BMI were not associated with reaching longevity. In women, non-occupational physical activity showed an inverse U-shaped association with reaching longevity, with the highest RR around 60 min of physical activity per day. In men, a positive linear association was observed between physical activity and reaching longevity.ConclusionThis study indicates that body size and physical activity are related to the likelihood of reaching 90 years of age and that these associations differ by sex.

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Atrial fibrillation diagnosed after stroke and dementia risk: cohort study of first-ever ischaemic stroke patients aged 65 or older

EP Europace ◽

10.1093/europace/euz237 ◽

2019 ◽

Vol 21 (12) ◽

pp. 1793-1801 ◽

Cited By ~ 6

Author(s):

Michal Krawczyk ◽

Sebastian Fridman ◽

Yi Cheng ◽

Jiming Fang ◽

Gustavo Saposnik ◽

...

Keyword(s):

Atrial Fibrillation ◽

Cohort Study ◽

Ischaemic Stroke ◽

Oral Anticoagulants ◽

Stroke Patients ◽

Stroke Registry ◽

Cardiovascular Comorbidities ◽

Hazard Ratios ◽

Dementia Risk ◽

Incident Dementia

Abstract Aims Atrial fibrillation (AF) is a risk factor for dementia among ischaemic stroke patients in whom the AF was known before the stroke (KAF). Atrial fibrillation detected after stroke (AFDAS) has a different profile compared to KAF, including less frequent cardiovascular comorbidities and lower CHA2-DS2-VASC scores. Currently, it is unknown if AFDAS is also associated with increased dementia risk. We assessed the association between AFDAS and the incident risk of dementia. We also evaluated whether the use of oral anticoagulants (OAC) was associated with lower dementia risk among AFDAS patients. Methods and results In this cohort study, we classified 9791 first-ever ischaemic stroke patients from the Ontario Stroke Registry into four groups: (i) No AF, (ii) KAF, (iii) Inpatient AFDAS (diagnosed during admission), and (iv) Outpatient AFDAS (diagnosed after discharge). We used multivariable Cox proportional models to estimate hazard ratios (HR) for the association between AFDAS and incident dementia risk. Dementia was determined through administrative datasets based on previously validated algorithms. In adjusted analyses, the dementia risk was higher for inpatient AFDAS [HR 1.78, 95% confidence interval (CI) 1.51–2.10] and outpatient AFDAS (HR 1.74, 95% CI 1.47–2.05) relative to no AF. Oral anticoagulants use was associated with lower dementia risk among patients with inpatient AFDAS (HR 0.58, 95% CI 0.43–0.79) and outpatient AFDAS (HR 0.60, 95% CI 0.43–0.83). Conclusion Atrial fibrillation detected after stroke was independently associated with higher risk of dementia relative to no AF. Among patients with AFDAS, the use of OACs was associated with lower dementia risk.

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