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Benzodiazepine & nonbenzodiazepine prescriptions for Taiwanese elderly with type 2 diabetes contributes to cognitive dysfunction

  • Yung-Rung Lai (a1), Yi-Sun Yang (a2) (a3), Min-Ling Tsai (a1), Chien-Ning Huang (a2) (a3) and Jeng-Yuan Chiou (a4)...

Abstract

Background:

This study examined the relationship of cognitive function and benzodiazepine/nonbenzodiazepine hypnotics (BZD/nonBZD) and other risk factors in a national sample of Taiwan's elderly diabetic patients.

Methods:

Data were drawn from the “2005 Taiwan National Health Interview Survey (NHIS)”, a population-based study of a national sample of adults aged 65 years and older. A total of 653 participants were included in this study. The Mini-Mental State Examination (MMSE) was used to evaluate patient's cognitive function for which the cut-off score is education-adjusted.

Results:

There were 130 participants left in the diabetic group and 523 participants in the control group. The average age was 74.2 and 73.3 respectively. The rate of cognitive dysfunction in DM and non DM participants was 11.5% (15/130) and 8.4% (44/523). Compared with those without diabetes in multivariate logistic regression, the odds ratio of cognitive impairment was 1.87-fold higher for diabetic patients (95% CI 1.04–3.61) after adjusting for sociodemographic characteristics, comorbidities, and BZD/nonBZD. Other factors were not significant. We performed an additional logistic analysis for which the odds ratio of cognitive impairment in diabetic patients with BZD/nonBZD was significantly increased to 2.41 (95% CI 1.08–5.40) than for patients without diabetes and BZD/nonBZD.

Conclusion:

In our research, cognitive dysfunction was associated with diabetes. BZD/nonBZD may have conferred additional risk of cognitive impairment in our elderly diabetic patients. We should consider examining the mental function of DM patients regularly and try our best to avoid potentially inappropriate medications (PIMs).

Copyright

Corresponding author

Correspondence should be addressed to: Jeng-Yuan Chiou, PhD, School of Health Policy and Management, Chung Shan Medical University, No.110, Sec.1, Jianguo N.Rd., Taichung City 40201, Taiwan. Phone: +886-4-24739595; Ext.: 38140; Fax: +886-4-23248155. Email: tom@csmu.edu.tw.

References

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American Geriatrics Society Beers Criteria Update Expert P. (2012). American Geriatrics Society updated Beers Criteria for potentially inappropriate medication use in older adults. Journal of the American Geriatrics Society, 60, 616631. doi: 10.1111/j.1532-5415.2012.03923.x.
Awad, N., Gagnon, M. and Messier, C. (2004). The relationship between impaired glucose tolerance, type 2 diabetes, and cognitive function. Journal of Clinical and Experimental Neuropsychology, 26, 10441080. doi: 10.1080/13803390490514875.
Biessels, G. J., Staekenborg, S., Brunner, E., Brayne, C. and Scheltens, P. (2006). Risk of dementia in diabetes mellitus: a systematic review. Lancet Neurology, 5, 6474. doi: 10.1016/S1474-4422(05)70284-2.
Buscemi, N. et al. (2007). The efficacy and safety of drug treatments for chronic insomnia in adults: a meta-analysis of RCTs. Journal of General Internal Medicine, 22, 13351350. doi: 10.1007/s11606-007-0251-z.
Crosby-Nwaobi, R., Sivaprasad, S. and Forbes, A. (2012). A systematic review of the association of diabetic retinopathy and cognitive impairment in people with Type 2 diabetes. Diabetes Research and Clinical Practice, 96, 101110. doi: 10.1016/j.diabres.2011.11.010.
Cukierman, T., Gerstein, H. C. and Williamson, J. D. (2005). Cognitive decline and dementia in diabetes–systematic overview of prospective observational studies. Diabetologia, 48, 24602469. doi: 10.1007/s00125-005-0023-4.
Cumming, R. G. and Le Couteur, D. G. (2003). Benzodiazepines and risk of hip fractures in older people: a review of the evidence. CNS Drugs, 17, 825837.
Euser, S. M., Schram, M. T., Hofman, A., Westendorp, R. G. and Breteler, M. M. (2008). Measuring cognitive function with age: the influence of selection by health and survival. Epidemiology, 19, 440447. doi: 10.1097/EDE.0b013e31816a1d31.
Folstein, M. F., Folstein, S. E. and McHugh, P. R. (1975). “Mini-mental state”. A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189198.
Glass, J., Lanctot, K. L., Herrmann, N., Sproule, B. A. and Busto, U. E. (2005). Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ, 331, 1169. doi: 10.1136/bmj.38623.768588.47.
Grad, R. M. (1995). Benzodiazepines for insomnia in community-dwelling elderly: a review of benefit and risk. The Journal of Family Practice, 41, 473481.
Gray, S. L. et al. (2006). Benzodiazepine use and physical disability in community-dwelling older adults. Journal of the American Geriatrics Society, 54, 224230. doi: 10.1111/j.1532-5415.2005.00571.x.
Guo, L. W., Liu, H. C. and Wong, P. F. (1988). Chinese version and norms of Mini-Mental State Examination. Journal of Chinese Rehabilitation Medicine, 16, 5259.
Holbrook, A. M., Crowther, R., Lotter, A., Cheng, C. and King, D. (2000). Meta-analysis of benzodiazepine use in the treatment of insomnia. CMAJ, 162, 225233.
Katz, S. and Akpom, C. A. (1976). A measure of primary sociobiological functions. International Journal of Health Services : Planning, Administration, Evaluation, 6, 493508.
Knopman, D. S., Mosley, T. H., Catellier, D. J., Coker, L. H. and Atherosclerosis Risk in Communities Study Brain, M. R. I. S. (2009). Fourteen-year longitudinal study of vascular risk factors, APOE genotype, and cognition: the ARIC MRI Study. Alzheimer's & Dementia, 5, 207214. doi: 10.1016/j.jalz.2009.01.027.
Lai, H. Y., Hwang, S. J., Chen, Y. C., Chen, T. J., Lin, M. H. and Chen, L. K. (2009). Prevalence of the prescribing of potentially inappropriate medications at ambulatory care visits by elderly patients covered by the Taiwanese National Health Insurance program. Clinical Therapeutics, 31, 18591870. doi: 10.1016/j.clinthera.2009.08.023.
Lawton, M. P. and Brody, E. M. (1969). Assessment of older people: self-maintaining and instrumental activities of daily living. The Gerontologist, 9, 179186.
Liu, C. K. (2006). The epidemiology of dementia in Taiwan. Acta Neurologica Taiwanica, 15, 5152.
Liu, H. C. et al. (1995). Prevalence and subtypes of dementia in Taiwan: a community survey of 5297 individuals. Journal of the American Geriatrics Society, 43, 144149.
Luchsinger, J. A., Reitz, C., Patel, B., Tang, M. X., Manly, J. J. and Mayeux, R. (2007). Relation of diabetes to mild cognitive impairment. Archives of Neurology, 64, 570575. doi: 10.1001/archneur.64.4.570.
Nowell, P. D., Mazumdar, S., Buysse, D. J., Dew, M. A., Reynolds, C. F. 3rd and Kupfer, D. J. (1997). Benzodiazepines and zolpidem for chronic insomnia: a meta-analysis of treatment efficacy. JAMA, 278, 21702177.
Petersen, R. C., Smith, G. E., Waring, S. C., Ivnik, R. J., Tangalos, E. G. and Kokmen, E. (1999). Mild cognitive impairment: clinical characterization and outcome. Archives of Neurology, 56, 303308.
Ryan, C. M. and Geckle, M. O. (2000). Circumscribed cognitive dysfunction in middle-aged adults with type 2 diabetes. Diabetes Care, 23, 14861493.
Stewart, R. and Liolitsa, D. (1999). Type 2 diabetes mellitus, cognitive impairment and dementia. Diabetic Medicine, 16, 93112.
Strachan, M. W., Deary, I. J., Ewing, F. M. and Frier, B. M. (1997). Is type II diabetes associated with an increased risk of cognitive dysfunction? A critical review of published studies. Diabetes Care, 20, 438445.
Strachan, M. W., Frier, B. M. and Deary, I. J. (2003). Type 2 diabetes and cognitive impairment. Diabetic Medicine, 20, 12.
Strachan, M. W., Price, J. F. and Frier, B. M. (2008). Diabetes, cognitive impairment, and dementia. BMJ, 336, 6. doi: 10.1136/bmj.39386.664016.BE.
Sussman, M. B. and Association, A. S. (1966). Sociology and Rehabilitation. Chicago, IL: American Sociological Association.
Tamblyn, R. M. et al. (1994). Questionable prescribing for elderly patients in Quebec. CMAJ, 150, 18011809.
Verdelho, A. et al. (2007). Differential impact of cerebral white matter changes, diabetes, hypertension and stroke on cognitive performance among non-disabled elderly. The LADIS study. Journal of Neurology, Neurosurgery, and Psychiatry, 78, 13251330. doi: 10.1136/jnnp.2006.110361.
Wild, S., Roglic, G., Green, A., Sicree, R. and King, H. (2004). Global prevalence of diabetes: estimates for the year 2000 and projections for 2030. Diabetes Care, 27, 10471053.
Yen, C. H. et al. (2010). Determinants of cognitive impairment over time among the elderly in Taiwan: results of the national longitudinal study. Archives of Gerontology and Geriatrics, 50 (Suppl. 1), S53–S57. doi: 10.1016/S0167-4943(10)70014-5.

Keywords

Benzodiazepine & nonbenzodiazepine prescriptions for Taiwanese elderly with type 2 diabetes contributes to cognitive dysfunction

  • Yung-Rung Lai (a1), Yi-Sun Yang (a2) (a3), Min-Ling Tsai (a1), Chien-Ning Huang (a2) (a3) and Jeng-Yuan Chiou (a4)...

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