title: Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors.
abstract: OBJECTIVE
  Selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment for depression. Among the SSRIs, paroxetine has strong anticholinergic properties and may lead to increased risk of adverse cognitive outcomes among elderly patients. This study evaluated the comparative risk of dementia associated with use of paroxetine and other SSRIs among elderly nursing home patients.
  
  
  METHODS
  A retrospective cohort study using propensity score matching was conducted with 2007-2010 Minimum Data Set-linked Medicare data. The study population included elderly nursing home patients with depression who were new users of SSRIs. Patients were followed for a maximum of two years after index SSRI use. The risk of dementia was modeled by using a robust Cox proportional hazards model to account for clustering within matched users of paroxetine and other SSRIs.
  
  
  RESULTS
  The unmatched cohort included 19,952 new users of SSRIs; 1,898 used paroxetine, and 18,054 used other SSRIs. In the propensity-matched cohort of 3,796 patients, the unadjusted incidence of dementia was 7.5% for users of paroxetine and 8.6% for users of other SSRIs. There was no difference in the risk of dementia for users of paroxetine or other SSRIs. These study findings remained robust in multiple sensitivity analyses involving various measures of dementia.
  
  
  CONCLUSIONS
  Compared with use of other SSRIs, use of paroxetine was not associated with higher risk of dementia among elderly nursing home patients with depression. Future studies are needed to evaluate the impact of paroxetine on other cognition measures.
authors.affiliation: Dr. Bali, Dr. Chatterjee, Dr. Chen, Dr. Johnson, and Dr. Aparasu are with the Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston. Dr. Carnahan is with the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City. Send correspondence to Dr. Aparasu (e-mail: rraparasu@uh.edu ).
authors.forename: Vishal
authors.initials: V
authors.lastname: Bali
authors.affiliation: Dr. Bali, Dr. Chatterjee, Dr. Chen, Dr. Johnson, and Dr. Aparasu are with the Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston. Dr. Carnahan is with the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City. Send correspondence to Dr. Aparasu (e-mail: rraparasu@uh.edu ).
authors.forename: Satabdi
authors.initials: S
authors.lastname: Chatterjee
authors.affiliation: Dr. Bali, Dr. Chatterjee, Dr. Chen, Dr. Johnson, and Dr. Aparasu are with the Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston. Dr. Carnahan is with the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City. Send correspondence to Dr. Aparasu (e-mail: rraparasu@uh.edu ).
authors.forename: Ryan M
authors.initials: RM
authors.lastname: Carnahan
authors.affiliation: Dr. Bali, Dr. Chatterjee, Dr. Chen, Dr. Johnson, and Dr. Aparasu are with the Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston. Dr. Carnahan is with the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City. Send correspondence to Dr. Aparasu (e-mail: rraparasu@uh.edu ).
authors.forename: Hua
authors.initials: H
authors.lastname: Chen
authors.affiliation: Dr. Bali, Dr. Chatterjee, Dr. Chen, Dr. Johnson, and Dr. Aparasu are with the Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston. Dr. Carnahan is with the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City. Send correspondence to Dr. Aparasu (e-mail: rraparasu@uh.edu ).
authors.forename: Michael L
authors.initials: ML
authors.lastname: Johnson
authors.affiliation: Dr. Bali, Dr. Chatterjee, Dr. Chen, Dr. Johnson, and Dr. Aparasu are with the Department of Pharmaceutical Health Outcomes and Policy, College of Pharmacy, University of Houston, Houston. Dr. Carnahan is with the Department of Epidemiology, College of Public Health, University of Iowa, Iowa City. Send correspondence to Dr. Aparasu (e-mail: rraparasu@uh.edu ).
authors.forename: Rajender R
authors.initials: RR
authors.lastname: Aparasu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015984:Causality; D015331:Cohort Studies; D015897:Comorbidity; D003704:Dementia / Q000453:epidemiology*; D003866:Depressive Disorder / Q000188:drug therapy* / Q000453:epidemiology; D005260:Female; D006707:Homes for the Aged; D006801:Humans; D008297:Male; D009735:Nursing Homes; D017374:Paroxetine / Q000009:adverse effects* / Q000627:therapeutic use; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012306:Risk; D017367:Selective Serotonin Reuptake Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D014481:United States / Q000453:epidemiology
chemical_list: D017374:Paroxetine; D017367:Selective Serotonin Reuptake Inhibitors