title: Dose-responsive effect of psychotropic drug use and subsequent dementia: a nationwide propensity score matched case-control study in Taiwan.
abstract: OBJECTIVE
  To test the hypothesis that the load of psychotropic agents was associated with subsequent dementia occurrence by a nationwide database.
  
  
  METHODS
  Propensity score matched case-control study.
  
  
  METHODS
  National Health Insurance Research database.
  
  
  METHODS
  A total of 32,649 older people with dementia and 32,649 matched dementia-free older people.
  
  
  METHODS
  Use of psychotropic drugs (anxiolytics, antipsychotics, hypnotics, and antidepressants), defined daily dose (DDD) of psychotropic drugs, diagnosis of dementia, and propensity score.
  
  
  METHODS
  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.
authors.affiliation: Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; School of Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan; Department of Pharmacy, National Taiwan University Hospital, Taipei, Taiwan.
authors.forename: Fei-Yuan
authors.initials: FY
authors.lastname: Hsiao
authors.affiliation: Institute of Public Health, National Yang Ming University, Taipei, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Li-Ning
authors.initials: LN
authors.lastname: Peng
authors.affiliation: Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.
authors.forename: Ming-Hsien
authors.initials: MH
authors.lastname: Lin
authors.affiliation: Institute of Public Health, National Yang Ming University, Taipei, Taiwan; Aging and Health Research Center, National Yang Ming University, Taipei, Taiwan; Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan. Electronic address: lkchen2@vghtpe.gov.tw.
authors.forename: Liang-Kung
authors.initials: LK
authors.lastname: Chen
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D016208:Databases, Factual; D003704:Dementia / Q000139:chemically induced*; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D008297:Male; D057216:Propensity Score; D011619:Psychotropic Drugs / Q000008:administration & dosage / Q000009:adverse effects*; D013624:Taiwan
chemical_list: D011619:Psychotropic Drugs
keywords: National Health Insurance database; Psychotropic agents; case-control study; cognition; dementia