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Cognitive enhancers associated with decreased risk of injury in patients with dementia: a nationwide cohort study in Taiwan
  1. Pei-Chun Chao1,
  2. Wu-Chien Chien2,3,
  3. Chi-Hsiang Chung2,3,4,
  4. Ching-Wen Chu1,
  5. Chin-Bin Yeh1,
  6. San-Yuan Huang1,
  7. Ru-Band Lu1,5,6,7,8,9,
  8. Hsin-An Chang1,10,
  9. Yu-Chen Kao1,11,
  10. Hui-Wen Yeh1,12,13,
  11. Wei-Shan Chiang1,14,
  12. Yu-Ching Chou15,
  13. Nian-Sheng Tzeng1,10
  1. 1 Department of Psychiatry, School of Medicine, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
  2. 2 Department of Medical Research, National Defense Medical Center, Tri-Service General Hospital, Taipei, Taiwan
  3. 3 School of Public Health, National Defense Medical Center, Taipei, Taiwan
  4. 4 Taiwanese Injury Prevention and Safety Promotion Association, Taipei, Taiwan
  5. 5 Division of Clinical Psychology, Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  6. 6 Department of Psychiatry, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  7. 7 Institute of Behavioral Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
  8. 8 Department of Psychiatry, National Cheng Kung University Hospital, Tainan, Taiwan
  9. 9 Center for Neuropsychiatric Research, National Health Research Institute, Miaoli County, Taiwan
  10. 10 Student Counseling Center, National Defense Medical Center, Taipei, Taiwan
  11. 11 Department of Psychiatry, Tri-Service General Hospital, Song-Shan Branch, National Defense Medical Center, Taipei, Taiwan
  12. 12 Department of Nursing, National Defense Medical Center, Tri-Service General Hospital and School of Nursing, Taipei, Taiwan
  13. 13 Institute of Bioinformatics and System Biology, National Ciao Tung University, Hsin-Chu, Taiwan
  14. 14 Department and Institute of Mathematics, Tamkang University, New Taipei City, Taiwan
  15. 15 School of Public Health, National Defense Medical Center, Taipei, Taiwan
  1. Correspondence to Dr Nian-Sheng Tzeng, Department of Psychiatry, National Defense Medical Center, Tri-Service General Hospital, School of Medicine, 114 Taipei, Taiwan; pierrens{at}mail.ndmctsgh.edu.tw

Abstract

This study aimed to investigate the associations among dementia, psychotropic medications and the risk of overall injuries. In this nationwide matched cohort study, a total of 144 008 enrolled patients ≥age of 50, with 36 002 study subjects who suffered from dementia and 108 006 controls matched for sex and age, from the Inpatient Dataset, for the period 2000–2010 in Taiwan were selected from the National Health Insurance Research Database, according to International Classification of Diseases, 9th Revision, Clinical Modification. When adjusting for the confounding factors, a Cox proportional hazards analysis was used to compare the risk of developing psychiatric disorders during the 10 years of follow-up. Of the study subjects, 6701 (18.61%) suffered injury when compared with 20 919 (19.37%) in the control group. The Cox regression analysis revealed that the study subjects were more likely to develop an injury (HR: 2.294, 95% CI=2.229 to 2.361, P<0.001) after adjusting for sex, age, monthly income, urbanization level, geographic region, and comorbidities. Psychotropic medications in the subjects with dementia were associated with the risk of injury (adjusted HR=0.217, 95% CI: 0.206 to 0.228, P<0.001). Cognitive enhancers, including acetylcholinesterase inhibitors and memantine, were associated with the risk of injury in the study subjects after being adjusted for all comorbidities and medications (adjusted HR=0.712(95% CI=0.512 to 0.925, P<0.01)). In conclusion, patients who suffered dementia had a higher risk of developing injury, and the cognitive enhancers were associated with the decreased risk of injury.

  • dementia
  • national health insurance research database
  • cohort study
  • cognitive enhancers

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Footnotes

  • Contributors P-CC and N-ST conceived of the study, participated in its design and coordination, data interpretation, performed the statistical analysis and drafted the manuscript. W-CC, C-HC, C-WC, C-BY , S-YH, R-BL and H-AC participated in the design of the study and data interpretation. C-HC, H-WY, W-SC and Y-CC participated in the statistical analysis and data interpretation. P-CC wrote the paper. All authors have read and approved the final manuscript as submitted.

  • Funding This work was supported by the Tri-Service General Hospital Research Foundation under the grants TSGH-C105-003, TSGH-C105-130, and TSGHC106-002.

  • Competing interests None declared.

  • Ethics approval This study was conducted in accordance with the Code of Ethics of the World Medical Association (Declaration of Helsinki). The Institutional Review Board of the Tri-Service General Hospital approved this study and waived the need of individual consents since all the identification data were encrypted in the NHIRD (IRB No. 2-104-05-126 and IRB No. 1-104-05-145).

  • Provenance and peer review Not commissioned; externally peer reviewed.

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