gms | German Medical Science

Background: Opioids are prescribed to treat moderate to severe acute and chronic pain. In Germany, the prescription rates of opioids have increased over the last decade. Elderly people use prescription opioid medications widely. While opioid use is a known risk factor for delirium, population-based studies on effects of opioids on cognition and dementia in the elderly are rare. The aim of our study was to investigate the association between prescription of opioids and incident any dementia in the elderly.

Materials and Methods: Longitudinal German public health insurance data from 2004 to 2011 were used to analyze the association between opioid prescription and incident any dementia. We examined patient samples aged 65 years or older that were free of dementia at baseline. Hazard ratios were calculated applying Cox regression with time-dependent covariates. The analysis was adjusted for potential confounding factors such as age, gender, comorbidities (stroke, depression, ischemic heart disease, diabetes) and polypharmacy. Next to opioids we included nonsteroidal anti-inflammatory drugs (NSAIDs) and other analgesics from the ATC code list into the analysis.

Results: Opioid prescription was associated with a significant increased risk of incident any dementia for patients aged 65 years or older. For the intake of NSAIDs a trend towards a protective effect was observed. Furthermore, the analysis confirmed known risk factors for dementia like depression, stroke and polypharmacy.

Conclusion: In view of dementia risk prescription of opioids in the elderly should be considered carefully. Large prospective studies with long follow-up periods are needed to confirm whether the association between opioid use and increased dementia risk in the elderly is causal.