Cognitive Outcomes of Long-term Benzodiazepine and Related Drug (BDZR) Use in People Living With Mild to Moderate Alzheimer's Disease: Results From NILVAD
| Autor: | Adam H. Dyer, Claire Murphy, Brian Lawlor, Sean P. Kennelly, Ricardo Segurado, Sean Kennelly, Marcel G.M. Olde Rikkert, Robert Howard, Florence Pasquier, Anne Börjesson-Hanson, Magda Tsolaki, Ugo Lucca, D. William Molloy, Robert Coen, Matthias W. Riepe, János Kálmán, Rose Anne Kenny, Fiona Cregg, Sarah O'Dwyer, Cathal Walsh, Jessica Adams, Rita Banzi, Laetitia Breuilh, Leslie Daly, Suzanne Hendrix, Paul Aisen, Siobhan Gaynor, Ali Sheikhi, Diana G. Taekema, Frans R. Verhey, Raffaello Nemni, Flavio Nobili, Massimo Franceschi, Giovanni Frisoni, Orazio Zanetti, Anastasia Konsta, Orologas Anastasios, Styliani Nenopoulou, Fani Tsolaki-Tagaraki, Magdolna Pakaski, Olivier Dereeper, Vincent de la Sayette, Olivier Sénéchal, Isabelle Lavenu, Agnès Devendeville, Gauthier Calais, Fiona Crawford, Michael Mullan, Pauline Aalten, Maria A. Berglund, Jurgen A. Claassen, Rianne A. De Heus, Daan L.K. De Jong, Olivier Godefroy, Siobhan Hutchinson, Aikaterini Ioannou, Michael Jonsson, Annette Kent, Jürgen Kern, Petros Nemtsas, Minoa-Kalliopi Panidou, Laila Abdullah, Daniel Paris, Angelina M. Santoso, Gerrita J. van Spijker, Martha Spiliotou, Georgia Thomoglou, Anders Wallin |
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| Přispěvatelé: | Laboratoire de Neurosciences Fonctionnelles et Pathologies - UR UPJV 4559 (LNFP), Université de Picardie Jules Verne (UPJV), Service de Neurologie, CHU Amiens-Picardie, University of Gothenburg (GU), Department of Psychiatry, Institute of Psychiatry, Institute of psychiatry, CHU Lille, Lille Neurosciences & Cognition - U 1172 (LilNCog), Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Mémoire de Ressources et de Recherche [Lille-Bailleul] (CMRR), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Hôpital Roger Salengro [Lille], Aristotle University of Thessaloniki, Istituto di Ricerce Farmacologiche Mario Negri, IRCCS - Istituto di Ricerche Farmacologiche 'Mario Negri' [Milan, Italy], University of San Diego (USD), Irish Clinical Research Infrastructures Network (ICRIN), Unità operativa di neurologia riabilitativa, Centro IRCCS Santa Maria Nascente', Fondazione Don Carlo Gnocchi, Università degli studi di Genova = University of Genoa (UniGe), Multimedica-Santa Maria, Castellanza, Université de Genève = University of Geneva (UNIGE), Istituto Centro San Giovanni di Dio Fatebenefratelli, Partenaires INRAE, IRCCS San Giovanni di Dio Fatebenefratelli, Laboratoire d'Automatique, de Mécanique et d'Informatique industrielles et Humaines - UMR 8201 (LAMIH), Centre National de la Recherche Scientifique (CNRS)-Université Polytechnique Hauts-de-France (UPHF)-INSA Institut National des Sciences Appliquées Hauts-de-France (INSA Hauts-De-France), Institut National des Sciences Appliquées (INSA)-Institut National des Sciences Appliquées (INSA), Maastricht University [Maastricht], Psychiatrie & Neuropsychologie, MUMC+: MA Med Staf Spec Psychiatrie (9), RS: MHeNs - R1 - Cognitive Neuropsychiatry and Clinical Neuroscience |
| Rok vydání: | 2020 |
| Předmět: |
cognition
medicine.medical_specialty Alzheimer`s disease Donders Center for Medical Neuroscience [Radboudumc 1] [SDV]Life Sciences [q-bio] Rate ratio law.invention 03 medical and health sciences 0302 clinical medicine Randomized controlled trial law Alzheimer Disease Internal medicine benzodiazepines benzodiazepines and related drugs cognition Dementia Medicine Dementia Humans 030212 general & internal medicine Cognitive decline Adverse effect OLDER-ADULTS benzodiazepines General Nursing Aged benzodiazepines and related drugs RISK DECLINE business.industry Health Policy General Medicine Odds ratio medicine.disease 3. Good health Women's cancers Radboud Institute for Health Sciences [Radboudumc 17] Europe Pharmaceutical Preparations Delirium Geriatrics and Gerontology Deprescribing medicine.symptom business DELIRIUM 030217 neurology & neurosurgery |
| Zdroj: | Journal of the American Medical Directors Association, 21, 2, pp. 194-200 Journal of the American Medical Directors Association Journal of the American Medical Directors Association, 2020, 21 (2), pp.194-200. ⟨10.1016/j.jamda.2019.08.006⟩ Journal of the American Medical Directors Association, 21, 194-200 Journal of the American Medical Directors Association, 21(2), 194-200. Elsevier Science |
| ISSN: | 1525-8610 |
| Popis: | Contains fulltext : 218263.pdf (Publisher’s version ) (Closed access) OBJECTIVE: Benzodiazepines and related drugs (BDZRs) have been associated with an increased risk of Alzheimer's disease (AD) in later life. Despite this, it remains unclear whether ongoing BDZR use may further accelerate cognitive decline in those diagnosed with mild to moderate AD. DESIGN: This study was embedded within NILVAD, a randomized controlled trial of nilvadipine in mild to moderate AD. Cognition was measured at baseline and 18 months using the Alzheimer Disease Assessment Scale, Cognitive Subsection (ADAS-Cog). We assessed predictors of long-term BDZR use and analyzed the effect of ongoing BDZR use on ADAS-Cog scores at 18 months. Additionally, the impact of BDZR use on adverse events, incident delirium, and falls over 18-month follow-up was assessed adjusting for relevant covariates. SETTING AND PARTICIPANTS: 448 participants with mild to moderate AD recruited from 23 academic centers in 9 European countries. RESULTS: Overall, 14% (62/448) were prescribed an ongoing BDZR for the study duration. Increasing total number of (non-BDZR) medications was associated with a greater likelihood of BDZR prescription (odds ratio 1.16, 95% confidence interval 1.05-1.29). At 18 months, BDZR use was not associated with greater cognitive decline on the ADAS-Cog controlling for baseline ADAS-Cog scores, age, gender, study arm, and other clinical covariates (beta = 1.62, -1.34 to 4.56). However, ongoing BDZR use was associated with a greater likelihood of adverse events [incidence rate ratio (IRR) 1.19, 1.05-1.34], incident delirium (IRR 2.31, 1.45-3.68), and falls (IRR 1.66, 1.02-2.65) over 18 months that persisted after robust adjustment for covariates. CONCLUSIONS AND IMPLICATIONS: This study found no effect of ongoing BDZR use on ADAS-Cog scores in those with mild to moderate AD over 18 months. However, ongoing use of these medications was associated with an increased risk of adverse events, delirium, and falls. Thus, BDZR use should be avoided where possible and deprescribing interventions should be encouraged in older adults with AD. |
| Databáze: | OpenAIRE |
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