title: Association Between Lithium Use and Risk of Alzheimer's Disease.
abstract: OBJECTIVE
  Current evidence for the association between use of lithium and risk of dementia is mixed. The objective of this study was to assess the risk of Alzheimer's disease associated with use of lithium.
  
  
  METHODS
  A population-based, nested case-control study was conducted using data from the National Health Insurance Research Database in 2002 covering 24.5 million beneficiaries of the Taiwan National Health Insurance Program from January 1, 1997, to December 31, 2009. A total of 2,548,625 older people were included in the study cohort. We analyzed 63,347 cases of Alzheimer's disease (ICD-9-CM codes 290.0-290.3, and 331.0) and 2 controls per case matched by age, sex, and index date (the date of the first AD claim). Conditional logistic regression was performed, adjusting for health care utilization, use of other common mood stabilizers (valproic acid and carbamazepine), hypothyroidism, type 2 diabetes, hypertension, hyperlipidemia, chronic kidney disease, epilepsy, schizophrenia, and bipolar disorder.
  
  
  RESULTS
  We identified 63,347 cases with Alzheimer's disease and 126,694 controls. The adjusted odds ratio (aOR) of Alzheimer's disease risk with lithium use was 1.79 (95% confidence interval [CI], 1.34-2.38) in the general population. However, when we restricted the analyses to patients with bipolar disorder to minimize potential confounding by indication, lithium was not associated with Alzheimer's disease risk (aOR = 1.36; 95% CI, 0.89-2.09), and there were no apparent trends of greater risk with increasing duration or dose.
  
  
  CONCLUSIONS
  These findings do not support an increased or decreased risk of lithium use with Alzheimer's disease when taking into account potential confounding by indication. Further investigations of the effect of lithium with dementia need to consider the influence of confounding by indication.
authors.affiliation: Department of Psychiatry, China Medical University Hospital, China Medical University, Taichung, Taiwan.|Translational Medicine Program, National Taiwan University and Academia Sinica, Taipei, Taiwan.
authors.forename: Chin
authors.initials: C
authors.lastname: Cheng
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Zandi
authors.affiliation: Department of Mental Health, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.|Department of Biostatistics, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.|Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Stuart
authors.affiliation: Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Ching-Heng
authors.initials: CH
authors.lastname: Lin
authors.affiliation: Department of Psychiatry, Taichung Veterans General Hospital, Taiwan.
authors.forename: Pei-Yu
authors.initials: PY
authors.lastname: Su
authors.affiliation: Center for Drug Safety and Effectiveness, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.|Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA.|Division of General Internal Medicine, Johns Hopkins Medicine, Baltimore, Maryland, USA.
authors.forename: G Caleb
authors.initials: GC
authors.lastname: Alexander
authors.affiliation: Department of Psychiatry, Taichung Veterans General Hospital, 450, Sec. 1, DongDa Rd, Taichung 407, Taiwan. thlan@ym.edu.tw.|Department of Psychiatry, Taichung Veterans General Hospital, Taiwan.|Department of Psychiatry, Faculty of Medicine, National Yang-Ming University, Taipei, Taiwan.|Center for Neuropsychiatric Research, National Health Research Institutes, Zhunan, Taiwan.|Center for Geriatrics and Gerontology, Taichung Veterans General Hospital, Taichung, Taiwan.
authors.forename: Tsuo-Hung
authors.initials: TH
authors.lastname: Lan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000544:Alzheimer Disease / Q000139:chemically induced* / Q000175:diagnosis / Q000453:epidemiology; D018692:Antimanic Agents / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy* / Q000453:epidemiology; D016022:Case-Control Studies; D015331:Cohort Studies; D015897:Comorbidity; D004305:Dose-Response Relationship, Drug; D005260:Female; D006801:Humans; D018020:Lithium Compounds / Q000009:adverse effects* / Q000627:therapeutic use; D008297:Male; D016017:Odds Ratio; D012306:Risk; D013223:Statistics as Topic; D013624:Taiwan
chemical_list: D018692:Antimanic Agents; D018020:Lithium Compounds