Reply To: Use Of Antiepileptic Drugs And Dementia Risk-An Analysis Of Finnish Health Register And German Health Insurance Data

ObjectivesTo evaluate the association between regular antiepileptic drug (AED) use and incident dementia. DesignCase-control analysis. SettingFinnish public health register and German health insurance data. ParticipantsIndividuals with dementia of any type (German data, N=20,325) and Alzheimer's disease (AD; Finnish data, N=70,718) were matched with up to four control persons without dementia. MeasurementsWe analyzed the association between regular AED use and dementia. To address potential protopathic bias, a lag time of 2 years between AED use and dementia diagnosis was introduced. Odds ratios (ORs) were calculated by applying conditional logistic regression, adjusted for potential confounding factors such as comorbidities and polypharmacy. ResultsRegular AED use was more frequent in individuals with dementia than controls. Regular use of AEDs was associated with a significantly greater risk of incident dementia (adjusted OR=1.28, 95% confidence interval (CI)=1.14-1.44) and AD (adjusted OR=1.15, 95% CI=1.09-1.22) than no AED use. We also detected a trend toward greater risk of dementia with higher exposure. When AEDs with and without known cognitive adverse effects (CAEs) were compared, a significantly greater risk of dementia was observed for substances with known CAEs (dementia: OR=1.59, 95% CI=1.36-1.86; AD: OR=1.19, 95% CI=1.11-1.27). ConclusionAEDs, especially those with known CAEs, may contribute to incident dementia and AD in older persons.