ArtikkelitTerveystieteiden Conflicts of Interest and Source of FundingVesa Tapiainen, Sirpa Hartikainen, Heidi Taipale and Anna-Maija Tolppanen report no competing interests. Jari Tiihonen reports serving as a consultant to AstraZeneca, Bristol-Myers Squibb, Eli Lilly, F. Hoffman-La Roche, Janssen-Cilag, Lundbeck, and Organon. He has received fees for giving expert opinions to AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Otsuka and Pfizer, and lecture fees from AstraZeneca, Bristol-Myers Squibb, Eli Lilly, GlaxoSmithKline, Janssen-Cilag, Lundbeck, Novartis, Otsuka, and Pfizer; and grant from Stanley Foundation and Sigrid Jusélius Foundation. He is a member of advisory board in AstraZeneca, Eli Lilly, Janssen-Cilag, and Otsuka.This work was supported by European Regional Development Fund (Regional Council of Pohjois-Savo) [32198 to Vesa Tapiainen, Heidi Taipale and Anna-Maija Tolppanen]. The funder had no role in study design; in the collection, analysis, and interpretation of data, in the writing of the report; and in the decision to submit the paper for publication. Conclusions:The associations between mental and behavioral disorders and AD were modest and dependent on the time window. Therefore, some of the disorders may represent misdiagnosed prodromal symptoms of AD which underlines the importance of proper differential diagnostics among older persons. These findings also highlight the importance of appropriate time window in psychiatric and neuroepidemiology research.
Benzodiazepine and related drug use in general was associated with modestly increased risk of AD. No major differences were observed between different subcategories of BZDRs (i.e. benzodiazepines, Z drugs, short-/medium-acting or long-acting BZDRs). As dose-response relationship abolished after adjustment for other psychotropics, it is possible that the association may partially be due to antidepressants and/or antipsychotics, or concomitant use of these medications.
BACKGROUND/OBJECTIVES Antipsychotic use is associated with risk of falls among older persons, but we are not aware of previous studies investigating risk of head injuries. We studied the association of antipsychotic use and risk of head injuries among community dwellers with Alzheimer's disease (AD). DESIGN Nationwide register‐based cohort study. SETTING Medication Use and Alzheimer's Disease (MEDALZ) cohort, Finland. PARTICIPANTS The MEDALZ cohort includes Finnish community dwellers who received clinically verified AD diagnosis in 2005 to 2011. Incident antipsychotic users were identified from the Prescription Register and matched with nonusers by age, sex, and time since AD diagnosis (21 795 matched pairs). Persons with prior head injury or history of schizophrenia were excluded. MEASUREMENTS Outcomes were incident head injuries (International Classification of Diseases, Tenth Revision [ICD‐10] codes S00‐S09) and traumatic brain injuries (TBIs; ICD‐10 codes S06.0‐S06.9) resulting in a hospital admission (Hospital Discharge Register) or death (Causes of Death Register). Inverse probability of treatment (IPT) weighted Cox proportional hazard models were used to assess relative risks. RESULTS Antipsychotic use was associated with an increased risk of head injuries (event rate per 100 person‐years = 1.65 [95% confidence interval {CI} = 1.50‐1.81] for users and 1.26 [95% CI = 1.16‐1.37] for nonusers; IPT‐weighted hazard ratio [HR] = 1.29 [95% CI = 1.14‐1.47]) and TBIs (event rate per 100 person‐years = 0.90 [95% CI = 0.79‐1.02] for users and 0.72 [95% CI = 0.65‐0.81] for nonusers; IPT‐weighted HR = 1.22 [95% CI = 1.03‐1.45]). Quetiapine users had higher risk of TBIs (IPT‐weighted HR = 1.60 [95% CI = 1.15‐2.22]) in comparison to risperidone users. CONCLUSIONS These findings imply that in addition to previously reported adverse events and effects, antipsychotic use may increase the risk of head injuries and TBIs in persons with AD. Therefore, their use should be restricted to most severe neuropsychiatric symptoms, as recommended by the AGS Beers Criteria®. Additionally, higher relative risk of TBIs in quetiapine users compared to risperidone users should be confirmed in further studies. J Am Geriatr Soc 68:595–602, 2020
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