Abstract
Objectives
To examine the association of benzodiazepines and anticholinergic drug usage with
the risk of dementia.
Design
Prospective cohort study.
Setting
Community-dwelling participants, recruited in family practices in the Netherlands.
Participants
In total, 3526 individuals aged 70 to 78 years without dementia within 116 participating
family practices.
Methods
Information about drug use was reported at baseline and at 2-year follow-up and was
cross-checked with the participants’ electronic health records. Anticholinergic drug
exposure was defined by the anticholinergic cognitive burden score. Participants were
evaluated for dementia during follow-up assessments every 2 years, supplemented by
information from electronic health records and the National Death Registry.
Results
During a median follow-up of 6.7 years, dementia developed in 233 participants (7%).
In participants using benzodiazepines, 6% developed dementia vs 7% in nonusers [hazard
ratio (HR) 0.71, 95% confidence interval (CI) 0.58–1.07]. Persistent usage of benzodiazepines
at baseline and after 2-year follow-up did not substantially alter the point-estimate
(HR 0.60, 95% CI 0.34–1.10). Use of any anticholinergic drugs was not associated with
incident dementia (HR 1.01, 95% CI 0.50–1.10). Dementia risk was significantly increased
for participants with persistent drug use with a high anticholinergic cognitive burden
score (HR 1.95, 95% CI 1.13–3.38) though this effect was absent when excluding participants
taking antidepressants or antipsychotics (HR 0.42, 95% CI 0.06–3.01).
Conclusions and Implications
In our study population, benzodiazepine usage was not associated with an increased
risk of dementia. Persistent high anticholinergic exposure was associated with an
increased risk of dementia over 6 years of follow-up, and this association was driven
by antidepressant or antipsychotic drug use, suggesting confounding by indication
bias contributing to this. Although this observation could ameliorate prescription
hesitance, healthcare providers are still advised to carefully weigh the potential
benefits of benzodiazepines and anticholinergic drugs against the associated adverse
health outcomes.
Keywords
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Article info
Publication history
Published online: July 09, 2019
Footnotes
The preDIVA trial was supported by the Dutch Ministry of Health,Welfare and Sport (grant number 50-50110-98-020), the Dutch Innovation Fund of Collaborative Health Insurances (grant number 05-234), and the Netherlands Organisation for Health Research and Development (grant number 62000015).
The authors declare no conflicts of interest.
Identification
Copyright
© 2019 AMDA - The Society for Post-Acute and Long-Term Care Medicine.
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