title: Effect of valproic acid on dementia onset in patients with bipolar disorder.
abstract: Valproic acid (VPA) is widely used for treating patients with bipolar disorder; however, it has adverse effects on cognitive function. This study investigated the effect of VPA on the risk of dementia in patients with bipolar disorder.
  
  
  
  We analyzed data from Taiwan's Longitudinal Health Insurance Database 2010. Patients with bipolar disorder who were prescribed VPA for 28 days or at least once per month for 3 consecutive months after the index date were classified as the VPA-treated group, whereas those who did not receive VPA were classified as the VPA-untreated group. Both groups were tracked until the end of 2013 or until loss to follow-up to identify new-onset dementia events. Multivariable Cox proportional hazards models were used to estimate the hazard ratio (HR) of subsequent dementia associated with VPA treatment after adjustment for confounding variables.
  
  
  
  The study comprised 5158 patients with bipolar disorder. The multivariable-adjusted HR for newly diagnosed dementia was 1.73 (95% confidence interval [CI], 1.24-2.41, P=0.001) for the VPA-treated group compared with the VPA-untreated group after adjustment for potential confounders. The VPA-treated group had a higher risk than did the VPA-untreated group after propensity score adjustment (HR=1.95, 95% CI=1.42-2.67, P<0.001).
  
  
  
  Certain variables that may affect the incidence of dementia were unavailable in the claims database and thus could not be considered.
  
  
  
  Treating bipolar disorder with VPA increases the risk of dementia by 73-95%.
authors.affiliation: School of Nursing, College of Nursing, Taipei Medical University, Taipei, Taiwan; Sleep Science Center, Taipei Medical University Hospital, Taipei, Taiwan.
authors.forename: Pei-Shan
authors.initials: PS
authors.lastname: Tsai
authors.affiliation: Department of Psychiatry, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan; Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
authors.forename: I-Chao
authors.initials: IC
authors.lastname: Liu
authors.affiliation: Department of Psychiatry, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan; Department of General Psychiatry, Taipei City Psychiatric Center, Taipei, Taiwan.
authors.forename: Chen-Huan
authors.initials: CH
authors.lastname: Chiu
authors.affiliation: Department of Anesthesiology, Taipei Tzu Chi Hospital, 289, Jian Gou Road, Sindian District, New Taipei City 23142, Taiwan; School of Medicine, Taipei Medical University, Taipei, Taiwan. Electronic address: huangcj1112@gmail.com.
authors.forename: Chun-Jen
authors.initials: CJ
authors.lastname: Huang
authors.affiliation: Department of Nursing, Cardinal Tien Junior College of Healthcare and Management, 112, Minzu Road, Sindian District, New Taipei City 23143, Taiwan. Electronic address: mywang@ctcn.edu.tw.
authors.forename: Mei-Yeh
authors.initials: MY
authors.lastname: Wang
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000175:diagnosis / Q000188:drug therapy* / Q000503:physiopathology; D015331:Cohort Studies; D016208:Databases, Factual; D003704:Dementia / Q000139:chemically induced* / Q000175:diagnosis / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D057216:Propensity Score; D013624:Taiwan / Q000453:epidemiology; D014635:Valproic Acid / Q000009:adverse effects* / Q000627:therapeutic use; D055815:Young Adult
chemical_list: D000927:Anticonvulsants; D014635:Valproic Acid
keywords: Bipolar disorder; Dementia; Mood stabilizers; Valproic acid