Islam Md Mohaimenul, Iqbal Usman, Walther Bruno, Atique Suleman, Dubey Navneet Kumar, Nguyen Phung-Anh, Poly Tahmina Nasrin, Masud Jakir Hossain Bhuiyan, Li Yu-Chuan Jack, Shabbir Syed-Abdul
Graduate Institute of Biomedical Informatics, College of Medical Science and Technology, Taipei Medical University, Taipei, Taiwan.
Neuroepidemiology. 2016;47(3-4):181-191. doi: 10.1159/000454881. Epub 2016 Dec 24.
Benzodiazepines are a widely used medication in developed countries, particularly among elderly patients. However, benzodiazepines are known to affect memory and cognition and might thus enhance the risk of dementia. The objective of this review is to synthesize evidence from observational studies that evaluated the association between benzodiazepines use and dementia risk.
We performed a systematic review and meta-analysis of controlled observational studies to evaluate the risk of benzodiazepines use on dementia outcome. All control observational studies that compared dementia outcome in patients with benzodiazepine use with a control group were included. We calculated pooled ORs using a random-effects model. Ten studies (of 3,696 studies identified) were included in the systematic review, of which 8 studies were included in random-effects meta-analysis and sensitivity analyses. Odds of dementia were 78% higher in those who used benzodiazepines compared with those who did not use benzodiazepines (OR 1.78; 95% CI 1.33-2.38). In subgroup analysis, the higher association was still found in the studies from Asia (OR 2.40; 95% CI 1.66-3.47) whereas a moderate association was observed in the studies from North America and Europe (OR 1.49; 95% CI 1.34-1.65 and OR 1.43; 95% CI 1.16-1.75). Also, diabetics, hypertension, cardiac disease, and statin drugs were associated with increased risk of dementia but negative association was observed in the case of body mass index. There was significant statistical and clinical heterogeneity among studies for the main analysis and most of the sensitivity analyses. There was significant statistical and clinical heterogeneity among the studies for the main analysis and most of the sensitivity analyses. Key Messages: Our results suggest that benzodiazepine use is significantly associated with dementia risk. However, observational studies cannot clarify whether the observed epidemiologic association is a causal effect or the result of some unmeasured confounding variable. Therefore, more research is needed.
苯二氮䓬类药物在发达国家广泛使用，尤其是在老年患者中。然而，已知苯二氮䓬类药物会影响记忆和认知，因此可能会增加患痴呆症的风险。本综述的目的是综合观察性研究的证据，以评估苯二氮䓬类药物的使用与痴呆症风险之间的关联。
我们对对照观察性研究进行了系统评价和荟萃分析，以评估使用苯二氮䓬类药物对痴呆症结局的风险。纳入了所有将使用苯二氮䓬类药物的患者与对照组的痴呆症结局进行比较的对照观察性研究。我们使用随机效应模型计算合并比值比。在系统评价中纳入了10项研究（从3696项研究中筛选出），其中8项研究纳入了随机效应荟萃分析和敏感性分析。使用苯二氮䓬类药物的患者患痴呆症的几率比未使用苯二氮䓬类药物的患者高78%（比值比1.78；95%置信区间1.33 - 2.38）。在亚组分析中，亚洲的研究中仍发现较高的关联（比值比2.40；95%置信区间1.66 - 3.47），而在北美和欧洲的研究中观察到中度关联（比值比1.49；95%置信区间1.34 - 1.65和比值比1.43；95%置信区间1.16 - 1.75）。此外，糖尿病、高血压、心脏病和他汀类药物与痴呆症风险增加相关，但体重指数与痴呆症风险呈负相关。在主要分析和大多数敏感性分析中，各研究之间存在显著的统计学和临床异质性。关键信息：我们的结果表明，使用苯二氮䓬类药物与痴呆症风险显著相关。然而，观察性研究无法阐明所观察到的流行病学关联是因果效应还是某些未测量的混杂变量的结果。因此，需要更多的研究。
