Objective

The risk of dementia associated with the use of psychotropic drugs is not fully understood. A nested case-control study was carried out to assess the risk of dementia broadly defined or Alzheimer’s disease associated with antidepressants, mood stabilizers or antipsychotics.

Methods

A cohort was formed from healthcare claim databases including all patients aged 50 and over with a first dispensing of the psychotropic drugs concerned between 2006 and 2017. Patients who developed dementia over the study period were considered as cases. The association between drug exposure prior to a five-year lag time and diagnosis of dementia was assessed by conditional logistic regression models.

Results

No association was found between dementia, either broadly defined or Alzheimer disease, and antidepressant or mood stabilizers. Findings were conflicting with regard to antipsychotics. First- and second-generation antipsychotics (FGA and SGA) were not associated with Alzheimer disease. SGA treatments of more than three months were associated with a higher risk of dementia broadly defined than no use of antipsychotics (Odds ratio (OR) 2.00; 95%CI 1.06-3.79; p=0.03). In a sensitivity analysis using a lag time of three years, ever use of SGA and SGA treatments of more than three months were associated with a higher risk of dementia broadly defined than no use of antipsychotics (OR 1.71; 1.10-2.67; p=0.02 and OR 1.84; 1.03-3.32; p=0.04, respectively).

Conclusion

The association between antipsychotics and dementia should be further investigated to establish patients, specific drugs, and patterns of treatment at risk. Prescribers should remain cautious when prescribing them.