Exposure to dementia and cognitive impairment-related potentially inappropriate medications in cases and controls.

<p>Exposure to dementia and cognitive impairment-related potentially inappropriate medications in cases and controls.</p

Prevalence of polypharmacy in cases and controls.

<p>Prevalence of polypharmacy in cases and controls.</p

The Association between Polypharmacy and Dementia: A Nested Case-Control Study Based on a 12-Year Longitudinal Cohort Database in South Korea

<div><p>Dementia is a major concern among growing chronic diseases in the aging society and its association with polypharmacy has not been adequately assessed. The objective of this study was to determine the association between polypharmacy and dementia through multiple statistical approaches. We conducted a nested case-control study for newly diagnosed dementia cases using the South Korean National Health Insurance Service sample cohort database (2002–2013, n = 1,025,340). Interactions between polypharmacy (an average use of ≥5 prescription drugs daily) and comorbidities or potentially inappropriate medications (PIMs) were tested. The odds ratios (ORs) for dementia were analyzed according to the presence of comorbidities, PIM uses, the average number of prescribed daily drugs, and significant interactions with polypharmacy using univariate and multiple logistic regression analyses. A higher prevalence of comorbidities, history of PIM use, higher PIM exposure, and higher proportion of polypharmacy were noted among cases than in controls. In the univariate analysis, the OR for dementia increased significantly with the increase in the number of prescribed drugs [1–<5 drugs: 1.72, 95% confidence interval (CI): 1.56–1.88; 5–<10 drugs: 2.64, 95% CI: 2.32–3.05; ≥10 drugs: 3.35, 95% CI: 2.38–4.71; <1 drug used as reference]. Polypharmacy was correlated with comorbidities and PIM use, and significant interactions were observed between polypharmacy and anticholinergics; H2-receptor antagonists; and comorbidities such as hypertension, peripheral or cerebrovascular disease, congestive heart failure, hemiplegia, diabetes, depression, all other mental disorders, chronic obstructive pulmonary disease, peptic ulcer disease, and chronic liver disease (p<0.001). In the multiple regression analysis, most cases exhibited increasing ORs for dementia with increasing polypharmacy levels. Moreover, the increase in OR was more evident in the absence of drugs or comorbidities that showed significant interactions with polypharmacy than in their presence. Polypharmacy increases the risk of PIM administration, and as some PIMs may have cognition-impairing effects, prolonged polypharmacy may result in dementia. Therefore, efforts are needed to limit or decrease the prescription of medications that have been associated with risk of dementia in the elderly.</p></div

Multivariable logistic regression analysis with or without interaction terms.

<p>Multivariable logistic regression analysis with or without interaction terms.</p

Selection of cases and controls.

<p>^a Alzheimer’s disease dementia: patients with ICD-10 codes of F00 and G30, without F01, F02, F03, F051, and G311. ^b Other cause dementia: patients with ICD-10 codes of F01, F02, F03, F051, and G311, without ICD-10 codes of F00 or G30 ^c Mixed dementia: patients with Alzheimer’s disease codes (F00 or G30) and any other cause dementia codes (F01, F02,F03, F051, G311) simultaneously.</p

Demographic and clinical information for cases and controls.

<p>Demographic and clinical information for cases and controls.</p

Univariate logistic regression analysis for polypharmacy and dementia segregated by patient subgroups.

<p>Univariate logistic regression analysis for polypharmacy and dementia segregated by patient subgroups.</p

The frequency and overlapping duration of co-medicated patients according to statin-contraindicated drug combination in 2009.

<p>SE = Standard error, Q1 = quartile 1, Q3 = quartile 3, ATV = atorvastatin, SMV = simvastatin, LOV = lovastatin, ITZ = itraconazole, CLA = clarithromycin, KTZ = ketoconazole, ERY = erythromycin.</p><p>Patients included in each type of co-medication patterns were not mutually exclusive.</p><p>The frequency and overlapping duration of co-medicated patients according to statin-contraindicated drug combination in 2009.</p

The proportion of patients co-medicated with statins and contraindicated drugs.

<p>SE = Standard error</p><p>*<i>p</i>-value was estimated by chi-square test.</p><p>The proportion of patients co-medicated with statins and contraindicated drugs.</p

The frequency and overlapping duration of co-medicated patients according to generic name of statin in 2009

<p>SE = Standard error, Q1 = quartile 1, Q3 = quartile 3.</p><p>Patients included in each type of co-medication pattern were not mutually exclusive.</p><p>The frequency and overlapping duration of co-medicated patients according to generic name of statin in 2009</p