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Lithium Receipt and Risk of Dementia in Older Veterans With Bipolar Disorder in the VA Health System
Older adults with bipolar disorder are at increased risk of developing dementia. The literature suggests lithium treatment may reduce the incidence of dementia. This study sought to inform clinical practice in the Veterans Affairs (VA) health system by estimating the effect of past year lithium rece...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Oxford University Press
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8680811/ http://dx.doi.org/10.1093/geroni/igab046.2073 |
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author | Szymanski, Benjamin Ahearn, Eileen Smith, Eric Jedele, Jenefer McCarthy, John Katz, Ira |
author_facet | Szymanski, Benjamin Ahearn, Eileen Smith, Eric Jedele, Jenefer McCarthy, John Katz, Ira |
author_sort | Szymanski, Benjamin |
collection | PubMed |
description | Older adults with bipolar disorder are at increased risk of developing dementia. The literature suggests lithium treatment may reduce the incidence of dementia. This study sought to inform clinical practice in the Veterans Affairs (VA) health system by estimating the effect of past year lithium receipt on dementia incidence among Veterans with bipolar disorder. Divalproex receipt was used as a comparison. Using VA medical records, 121,094 Veterans aged 50 and older with a diagnosis of bipolar disorder but no dementia diagnosis were identified in fiscal years 2005-2019. Follow-up continued until dementia diagnosis, 36 months from the index date, death, or the end of fiscal year 2020, whichever came first. 4347 (3.6%) were diagnosed with dementia during follow-up. Time-varying indicators of receipt of lithium and divalproex in the prior 365 days were calculated for each day, categorized as 301-365, 61-300, 1-60, or 0 days of receipt. Unadjusted Cox proportional hazards regression analyses indicated reduced dementia incidence with 301-365 (HR=0.86, 95% Confidence Interval [95%CI] 0.75-0.99) and 61-300 (HR=0.75, 95%CI 0.65-0.87) days of lithium receipt, compared to 0 days. For divalproex, 301-365 (HR=1.34, 95%CI 1.23-1.47) and 61-300 (HR=1.13, 95%CI 1.03-1.23) days of receipt were each associated with increased dementia incidence. Lithium effects were not statistically significant after adjusting for age, sex, race, ethnicity, medical comorbidities, and antidepressant, antipsychotic, and anxiolytic medication receipt. Divalproex effects remained statistically significant. Past year divalproex, but not lithium, receipt was significantly associated with dementia incidence among VA patients with bipolar disorder when adjusting for demographics and medical comorbidities. |
format | Online Article Text |
id | pubmed-8680811 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Oxford University Press |
record_format | MEDLINE/PubMed |
spelling | pubmed-86808112021-12-17 Lithium Receipt and Risk of Dementia in Older Veterans With Bipolar Disorder in the VA Health System Szymanski, Benjamin Ahearn, Eileen Smith, Eric Jedele, Jenefer McCarthy, John Katz, Ira Innov Aging Abstracts Older adults with bipolar disorder are at increased risk of developing dementia. The literature suggests lithium treatment may reduce the incidence of dementia. This study sought to inform clinical practice in the Veterans Affairs (VA) health system by estimating the effect of past year lithium receipt on dementia incidence among Veterans with bipolar disorder. Divalproex receipt was used as a comparison. Using VA medical records, 121,094 Veterans aged 50 and older with a diagnosis of bipolar disorder but no dementia diagnosis were identified in fiscal years 2005-2019. Follow-up continued until dementia diagnosis, 36 months from the index date, death, or the end of fiscal year 2020, whichever came first. 4347 (3.6%) were diagnosed with dementia during follow-up. Time-varying indicators of receipt of lithium and divalproex in the prior 365 days were calculated for each day, categorized as 301-365, 61-300, 1-60, or 0 days of receipt. Unadjusted Cox proportional hazards regression analyses indicated reduced dementia incidence with 301-365 (HR=0.86, 95% Confidence Interval [95%CI] 0.75-0.99) and 61-300 (HR=0.75, 95%CI 0.65-0.87) days of lithium receipt, compared to 0 days. For divalproex, 301-365 (HR=1.34, 95%CI 1.23-1.47) and 61-300 (HR=1.13, 95%CI 1.03-1.23) days of receipt were each associated with increased dementia incidence. Lithium effects were not statistically significant after adjusting for age, sex, race, ethnicity, medical comorbidities, and antidepressant, antipsychotic, and anxiolytic medication receipt. Divalproex effects remained statistically significant. Past year divalproex, but not lithium, receipt was significantly associated with dementia incidence among VA patients with bipolar disorder when adjusting for demographics and medical comorbidities. Oxford University Press 2021-12-17 /pmc/articles/PMC8680811/ http://dx.doi.org/10.1093/geroni/igab046.2073 Text en © The Author(s) 2021. Published by Oxford University Press on behalf of The Gerontological Society of America. https://creativecommons.org/licenses/by/4.0/This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) ), which permits unrestricted reuse, distribution, and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Abstracts Szymanski, Benjamin Ahearn, Eileen Smith, Eric Jedele, Jenefer McCarthy, John Katz, Ira Lithium Receipt and Risk of Dementia in Older Veterans With Bipolar Disorder in the VA Health System |
title | Lithium Receipt and Risk of Dementia in Older Veterans With Bipolar Disorder in the VA Health System |
title_full | Lithium Receipt and Risk of Dementia in Older Veterans With Bipolar Disorder in the VA Health System |
title_fullStr | Lithium Receipt and Risk of Dementia in Older Veterans With Bipolar Disorder in the VA Health System |
title_full_unstemmed | Lithium Receipt and Risk of Dementia in Older Veterans With Bipolar Disorder in the VA Health System |
title_short | Lithium Receipt and Risk of Dementia in Older Veterans With Bipolar Disorder in the VA Health System |
title_sort | lithium receipt and risk of dementia in older veterans with bipolar disorder in the va health system |
topic | Abstracts |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8680811/ http://dx.doi.org/10.1093/geroni/igab046.2073 |
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