title: Benzodiazepine use and risk of incident dementia or cognitive decline: prospective population based study.
abstract: OBJECTIVE
  To determine whether higher cumulative use of benzodiazepines is associated with a higher risk of dementia or more rapid cognitive decline.
  
  
  METHODS
  Prospective population based cohort.
  
  
  METHODS
  Integrated healthcare delivery system, Seattle, Washington.
  
  
  METHODS
  3434 participants aged ≥ 65 without dementia at study entry. There were two rounds of recruitment (1994-96 and 2000-03) followed by continuous enrollment beginning in 2004.
  
  
  METHODS
  The cognitive abilities screening instrument (CASI) was administered every two years to screen for dementia and was used to examine cognitive trajectory. Incident dementia and Alzheimer's disease were determined with standard diagnostic criteria. Benzodiazepine exposure was defined from computerized pharmacy data and consisted of the total standardized daily doses (TSDDs) dispensed over a 10 year period (a rolling window that moved forward in time during follow-up). The most recent year was excluded because of possible use for prodromal symptoms. Multivariable Cox proportional hazard models were used to examine time varying use of benzodiazepine and dementia risk. Analyses of cognitive trajectory used linear regression models with generalized estimating equations.
  
  
  RESULTS
  Over a mean follow-up of 7.3 years, 797 participants (23.2%) developed dementia, of whom 637 developed Alzheimer's disease. For dementia, the adjusted hazard ratios associated with cumulative benzodiazepine use compared with non-use were 1.25 (95% confidence interval 1.03 to 1.51) for 1-30 TSDDs; 1.31 (1.00 to 1.71) for 31-120 TSDDs; and 1.07 (0.82 to 1.39) for ≥ 121 TSDDs. Results were similar for Alzheimer's disease. Higher benzodiazepine use was not associated with more rapid cognitive decline.
  
  
  CONCLUSIONS
  The risk of dementia is slightly higher in people with minimal exposure to benzodiazepines but not with the highest level of exposure. These results do not support a causal association between benzodiazepine use and dementia.
authors.affiliation: School of Pharmacy, University of Washington, Seattle, WA 98195-7630, US slgray@u.washington.edu.
authors.forename: Shelly L
authors.initials: SL
authors.lastname: Gray
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA, US.
authors.forename: Sascha
authors.initials: S
authors.lastname: Dublin
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA, US.
authors.forename: Onchee
authors.initials: O
authors.lastname: Yu
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA, US.
authors.forename: Rod
authors.initials: R
authors.lastname: Walker
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA, US.
authors.forename: Melissa
authors.initials: M
authors.lastname: Anderson
authors.affiliation: Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Pennsylvania, PA, US.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Hubbard
authors.affiliation: University of Washington Department of Medicine, Division of General Internal Medicine, Seattle, WA, US.
authors.forename: Paul K
authors.initials: PK
authors.lastname: Crane
authors.affiliation: Group Health Research Institute, Group Health Cooperative, Seattle, WA, US.
authors.forename: Eric B
authors.initials: EB
authors.lastname: Larson
mesh_terms: D000368:Aged; D000544:Alzheimer Disease / Q000139:chemically induced / Q000453:epidemiology; D014151:Anti-Anxiety Agents / Q000009:adverse effects* / Q000627:therapeutic use; D000928:Antidepressive Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001569:Benzodiazepines / Q000009:adverse effects* / Q000627:therapeutic use; D003072:Cognition Disorders / Q000139:chemically induced / Q000453:epidemiology*; D003704:Dementia / Q000139:chemically induced / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D011159:Population Surveillance; D011446:Prospective Studies; D012307:Risk Factors; D014861:Washington / Q000453:epidemiology
chemical_list: D014151:Anti-Anxiety Agents; D000928:Antidepressive Agents; D001569:Benzodiazepines
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