Department of Community Medicine and Rehabilitation, Geriatric Medicine, Umeå University, Umeå, Sweden.
Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, Umeå, Sweden.
BMC Pharmacol Toxicol. 2017 May 25;18(1):36. doi: 10.1186/s40360-017-0142-9.
Psychotropic drugs are common among old people with dementia, and have been associated with increased mortality. Previous studies have not investigated sex differences in this risk. This study was conducted to analyse associations between the use of antipsychotics, antidepressants, and benzodiazepines and 2-year mortality in old people with dementia, and to investigate sex differences therein.
In total, 1037 participants (74% women; mean age, 89 years) with dementia were included from four cohort studies and followed for 2 years. Data were collected through home visits and medical records. Cox proportional hazard regression models were used to analyse associations between ongoing baseline drug use and mortality. Multiple possible confounders were evaluated and adjusted for.
In fully adjusted models including data from the whole population, no association between baseline psychotropic drug use and increased 2-year mortality was seen. Significant sex differences were found in mortality associated with antidepressant use, which was protective in men, but not in women (hazard ratio [HR] 0.61, 95% confidence interval [CI] 0.40-0.92 and HR 1.09, 95% CI 0.87-1.38, respectively). The interaction term for sex was significant in analyses of benzodiazepine use, with a higher mortality risk among men than among women.
Among old people with dementia, ongoing psychotropic drug use at baseline was not associated with increased mortality in analyses adjusted for multiple confounders. Sex differences in mortality risk associated with antidepressant and benzodiazepine use were seen, highlighting the need for further investigation of the impact of sex.
精神药物在老年痴呆症患者中很常见，并且与死亡率增加有关。以前的研究并未调查这种风险的性别差异。本研究旨在分析抗精神病药、抗抑郁药和苯二氮䓬类药物在老年痴呆症患者中的使用与 2 年死亡率之间的关系，并调查其中的性别差异。
共有 1037 名来自四项队列研究的痴呆症患者（74%为女性；平均年龄 89 岁）入组并随访 2 年。数据通过家访和病历收集。采用 Cox 比例风险回归模型分析基线药物使用与死亡率之间的关系。评估并调整了多个可能的混杂因素。
在包括整个人群数据的完全调整模型中，基线精神药物使用与 2 年死亡率增加之间没有关联。在与抗抑郁药使用相关的死亡率方面存在显著的性别差异，在男性中具有保护作用，但在女性中则没有（危险比 [HR] 0.61，95%置信区间 [CI] 0.40-0.92 和 HR 1.09，95% CI 0.87-1.38）。在苯二氮䓬类药物使用的分析中，性别交互项具有统计学意义，男性的死亡率风险高于女性。
在老年痴呆症患者中，在调整了多个混杂因素后，基线时持续使用精神药物与死亡率增加无关。与抗抑郁药和苯二氮䓬类药物使用相关的死亡率风险存在性别差异，这突显了进一步研究性别的影响的必要性。
