Link Between Epilepsy Drugs and Increased Risk of Dementia

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MedicalResearch.com Interview with:
Britta Haenisch, PhD

Pharmacoepidemiology in Neurodegenerative Disorders
German Center for Neurodegenerative Diseases,
DZNE 

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Antiepileptic drugs (AEDs) have been shown to affect cognition by suppressing neuronal excitability and increasing inhibitory neurotransmission. Previous studies suggested that AEDs may be associated with cognitive adverse effects. Therefore, we evaluated the association between AED use and incident dementia and Alzheimer’s disease (AD).

We utilized large longitudinal datasets from Finnish health registers and from German health insurance data. The case-control analyses was adjusted for several potential confounders like comorbidities and polypharmacy. The inclusion of a lag time between . Antiepileptic drugs use and dementia diagnosis allowed minimization of protopathic bias.

Our study provides an association between regular prescription of  antiepileptic drugs with known cognitive adverse effects and the occurrence of dementia and AD in patients aged 65 years and older. 

MedicalResearch.com: What should readers take away from your report?

Response: Our study is the first study on the association of .antiepileptic drugs use and dementia risk based on large longitudinal insurance and health register data. Comparable results were observed in the Finnish and German datasets. The results have to be confirmed in further studies. Clinicians always should weigh up the benefits of drugs against potential side effects. This holds true especially for drugs with relatively narrow therapeutic indices that are prescribed to older patients where age-related changes may increase the risk for adverse drug events. 

MedicalResearch.com: What recommendations do you have for future research as a result of this work?

Response: The study can only provide a statistical association, it does not prove that antiepileptic drugs with cognitive adverse effects cause dementia. To evaluate cause and effect relationships between long-term AED use and possible effects on cognition and dementia, large randomized, prospective clinical studies are needed.

MedicalResearch.com: Is there anything else you would like to add? 

Response: We are grateful to the Scientific Research Institute of the AOK (WIdO) and Finnish health care registers for providing the data. 

Citations:

Heidi Taipale, Willy Gomm, Karl Broich, Wolfgang Maier, Anna-Maija Tolppanen, Antti Tanskanen, Jari Tiihonen, Sirpa Hartikainen, Britta Haenisch. Use of Antiepileptic Drugs and Dementia Risk-an Analysis of Finnish Health Register and German Health Insurance Data. Journal of the American Geriatrics Society, 2018; DOI: 1111/jgs.15358 

 

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One thought on “Link Between Epilepsy Drugs and Increased Risk of Dementia

  1. J Am Geriatr Soc. 2017 May;65(5):1043-1050. doi: 10.1111/jgs.14756. Epub 2017 Feb 8.
    PTSD, Psychotropic Medication Use, and the Risk of Dementia Among US Veterans: A Retrospective Cohort Study.
    Mawanda F1, Wallace RB1,2, McCoy K3, Abrams TE1,2,3.
    Abstract
    OBJECTIVE:
    To determine the associations between PTSD, psychotropic medication use, and the risk for dementia.
    DESIGN:
    Retrospective cohort.
    PARTICIPANTS:
    Nationwide sample of US veterans (N = 417,172) aged ≥56 years during fiscal year (FY) 2003 without a diagnosis of dementia or mild cognitive impairment at baseline (FY02-03) and ≥1 clinical encounter every 2 years during follow-up (FY04-12).
    MEASURES:
    Demographic characteristics; diagnosis of PTSD, dementia, and medical and psychiatric comorbidity (defined by ICD-9 codes); and psychotropic medication use including selective serotonin reuptake inhibitors (SSRI), serotonin-norepinephrine reuptake inhibitors (SNRI), novel antidepressants (NA), benzodiazepines (BZA), and atypical antipsychotics (AA). Cox proportional hazard models examined for associations between PTSD diagnosis, psychotropic medication use, and risk for a dementia diagnosis.
    RESULTS:
    PTSD diagnosis significantly increased the risk for dementia diagnosis (HR = 1.35; [95% CI = 1.27-1.43]). However, there were significant interactions between PTSD diagnosis and use of SSRIs (P < .001), NAs (P = .014), and AAs (P < .001) on the risk for dementia diagnosis. HR for dementia diagnosis among veterans diagnosed with PTSD and not using psychotropic medications was 1.55 [1.45-1.67]. Among veterans diagnosed with PTSD prescribed SSRI, SNRI, or AA, HR for dementia diagnosis varied by drug class use ranging from 1.99 for SSRI to 4.21 for AA, relative to veterans without a PTSD diagnosis and no psychotropic medication receipt. BZAs or SNRIs use at baseline was associated with a significantly increased risk for dementia diagnosis independent of a PTSD diagnosis.
    CONCLUSION:
    PTSD diagnosis is associated with an increased risk for dementia diagnosis that varied with receipt of psychotropic medications. Further research would help to delineate if these findings are due to differences in PTSD severity, psychiatric comorbidity, or independent effects of psychotropic medications on cognitive decline.

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