Benzodiazepine use and risk of Alzheimer's disease: case-control study.
Benzodiazepine use and risk of Alzheimer's disease: case-control study.
复制标题
DOI：
10.1136/bmj.g5205
复制
发表时间：
2014-09-09
期刊：
影响因子：
--
通讯作者：
Bégaud B
中科院分区：
文献类型：
--
作者：
Billioti de Gage S;Moride Y;Ducruet T;Kurth T;Verdoux H;Tournier M;Pariente A;Bégaud B
目的研究阿尔茨海默病风险与至少5年前开始接触苯二氮卓类药物之间的关系，考虑剂量-反应关系和可能与治疗相关的焦虑、抑郁、失眠。设计病例对照研究。设置魁北克健康保险计划数据库（RAMQ）。参与者1796人首次诊断为阿尔茨海默病，并随访至少6年，与7184名对照组在性别，年龄组和随访时间上相匹配。这两个群体都是从2000-09年居住在社区的老年人（年龄>66岁）中随机抽样的。主要结果测量阿尔茨海默病和苯二氮卓类药物使用之间的关联在诊断前至少5年开始，通过多变量条件logistic回归进行评估。首先考虑是否曾经暴露于苯二氮卓类药物，然后根据累积剂量（表示为处方日剂量（1-90、91-180、>180））和药物消除半衰期进行分类。结果：曾使用苯二氮卓类药物与阿尔茨海默病风险增加相关（调整后的比值比为1.51，95%置信区间为1.36 ~ 1.69;进一步调整焦虑、抑郁和失眠并没有显著改变该结果：1.43，1.28 ~ 1.60）。未发现累积剂量<91处方日剂量的相关性。随着暴露密度的增加，关联强度增加（91-180处方日剂量为1.32（1.01至1.74），（1.62至2.08）>180处方日剂量）和药物半衰期（短效药1.43（1.27 ~ 1.61），长效药1.70（1.46 ~ 1.98））。结论苯二氮卓类药物的使用与阿尔茨海默病的风险增加有关。长期暴露观察到的更强的相关性加强了对可能直接相关性的怀疑，即使苯二氮卓类药物的使用也可能是与痴呆风险增加相关的疾病的早期标志物。不必要的长期使用这些药物应被视为公共卫生问题。
Objectives To investigate the relation between the risk of Alzheimer’s disease and exposure to benzodiazepines started at least five years before, considering both the dose-response relation and prodromes (anxiety, depression, insomnia) possibly linked with treatment. Design Case-control study. Setting The Quebec health insurance program database (RAMQ). Participants 1796 people with a first diagnosis of Alzheimer’s disease and followed up for at least six years before were matched with 7184 controls on sex, age group, and duration of follow-up. Both groups were randomly sampled from older people (age >66) living in the community in 2000-09. Main outcome measure The association between Alzheimer’s disease and benzodiazepine use started at least five years before diagnosis was assessed by using multivariable conditional logistic regression. Ever exposure to benzodiazepines was first considered and then categorised according to the cumulative dose expressed as prescribed daily doses (1-90, 91-180, >180) and the drug elimination half life. Results Benzodiazepine ever use was associated with an increased risk of Alzheimer’s disease (adjusted odds ratio 1.51, 95% confidence interval 1.36 to 1.69; further adjustment on anxiety, depression, and insomnia did not markedly alter this result: 1.43, 1.28 to 1.60). No association was found for a cumulative dose <91 prescribed daily doses. The strength of association increased with exposure density (1.32 (1.01 to 1.74) for 91-180 prescribed daily doses and 1.84 (1.62 to 2.08) for >180 prescribed daily doses) and with the drug half life (1.43 (1.27 to 1.61) for short acting drugs and 1.70 (1.46 to 1.98) for long acting ones). Conclusion Benzodiazepine use is associated with an increased risk of Alzheimer’s disease. The stronger association observed for long term exposures reinforces the suspicion of a possible direct association, even if benzodiazepine use might also be an early marker of a condition associated with an increased risk of dementia. Unwarranted long term use of these drugs should be considered as a public health concern.
登录
查看更多内容
影响因子：
6.9
作者：
Curran, HV;Collins, R;Iliffe, S
通讯作者：
Iliffe, S
DOI：
10.1177/0269881113495118
发表时间：
2013-09
期刊：
Journal of psychopharmacology (Oxford, England)
影响因子：
--
作者：
Fineberg NA;Haddad PM;Carpenter L;Gannon B;Sharpe R;Young AH;Joyce E;Rowe J;Wellsted D;Nutt DJ;Sahakian BJ
通讯作者：
Sahakian BJ
影响因子：
168.9
作者：
Ballard, Clive;Gauthier, Serge;Jones, Emma
通讯作者：
Jones, Emma
影响因子：
7.2
作者：
DEYO, RA;CHERKIN, DC;CIOL, MA
通讯作者：
CIOL, MA
影响因子：
14.5
作者：
Johansson, Lena;Guo, Xinxin;Skoog, Ingmar
通讯作者：
Skoog, Ingmar