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Lithium treatment and risk for dementia in adults with bipolar disorder: Population-based cohort study

  • Tobias Gerhard (a1), D. P. Devanand (a2), Cecilia Huang (a3), Stephen Crystal (a3) and Mark Olfson (a4)...

Abstract

Background

Lithium inhibits glycogen synthase kinase-3, an enzyme implicated in the pathogenesis of dementia.

Aims

To examine the association of lithium and dementia risk in a large claims-based US cohort of publicly insured older adults with bipolar disorder.

Method

The cohort included individuals ⩾50 years diagnosed with bipolar disorder who did not receive dementia-related services during the prior year. Each follow-up day was classified by past-year cumulative duration of lithium use (0, 1–60, 61–300 and 301–365 days). Dementia diagnosis was the study outcome. Anticonvulsants commonly used as mood stabilisers served as a negative control.

Results

Compared with non-use, 301–365 days of lithium exposure was associated with significantly reduced dementia risk (hazard ratio (HR) = 0.77, 95% CI 0.60–0.99). No corresponding association was observed for shorter lithium exposures (HR = 1.04, 95% CI 0.83–1.31 for 61–300 days; HR = 1.07, 95% CI 0.67–1.71 for 1–60 days) or for any exposure to anticonvulsants.

Conclusions

Continuous lithium treatment may reduce dementia risk in older adults with bipolar disorder.

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Copyright

Corresponding author

Tobias Gerhard, PhD, Ernest Mario School of Pharmacy and Institute for Health, Health Care Policy, and Aging Research, Rutgers, The State University of New Jersey, 112 Paterson Street, New Brunswick, NJ 08901, USA. Email: tgerhard@rci.rutgers.edu

Footnotes

Hide All

An earlier version of this research was, in part, presented at the American Society for Clinical Pharmacology and Therapeutics (ASCPT) 2014 Annual Meeting, 18–22 March 2014, Atlanta, Georgia, USA.

See invited commentary, pp. 52–54, this issue.

Declaration of interest

D.P.D. is a consultant for Abbvie and Lundbeck.

Footnotes

References

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Lithium treatment and risk for dementia in adults with bipolar disorder: Population-based cohort study

  • Tobias Gerhard (a1), D. P. Devanand (a2), Cecilia Huang (a3), Stephen Crystal (a3) and Mark Olfson (a4)...
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eLetters

Comorbid depression in bipolar disorder?

Shian Ming Tan, Psychiatrist, Singapore General Hospital
31 August 2015

This paper is, in essence, a registry-based study. It is noteworthy that one of the comorbidities considered in this paper is depression – which runs contrary to conventional nosology/diagnostic consideration in psychiatry. This highlights one of the issues with registry data – diagnoses are established by physicians of different diagnostic capabilities, and may hence be inaccurate. It is surprising that the authors did not detect this and went so far as to include this as a confounder in adjusted analysis. ... More

Conflict of interest: None Declared

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