A Danish study has uncovered a significant link between cumulative opioid use and heightened dementia risk in adults over 60, but only beyond a specific threshold of use. The research, conducted by Dr Nelsan Pourhadi and colleagues at Copenhagen University Hospital Rigshospitalet, analysed data from nearly 1.9 million individuals and was published in JAMA Network Open. According to a study published on PubMed, long-term opioid use may be associated with an increased risk of dementia in patients with chronic pain, highlighting the need for cautious prescribing and monitoring of opioid use in this population, considering the potential long-term cognitive implications. Additionally, a MarketWatch article reports that older adults who start taking opioids after a dementia diagnosis are 11 times more likely to die within the first two weeks of taking the drugs, with known side effects including sedation, confusion, inadequate breathing, and falls.
The findings revealed that cumulative opioid exposure exceeding 90 total standardised doses (TSDs) – equivalent to 90 treatment days of 30 milligrams of morphine per day – was associated with increased dementia risk. For those aged 60-69, exposure between 91 and 200 TSDs corresponded to a 29% higher incidence rate of dementia, while exposure beyond 500 TSDs raised the risk by 59%. Similar trends were observed in older age groups, though the risks were somewhat reduced. For individuals aged 70-79, the risk ranged from 16% to 49% higher, and for those 80-89, the increase was between 8% and 21%. Notably, no significant association was found for cumulative opioid use below 90 TSDs.
The study focused on individuals without previous diagnoses of dementia, cancer, or opioid addiction, drawing on prescription data from 1995 to 2020 through Danish national registers. Researchers employed a nested case-control design, matching 93,638 people who developed dementia during the follow-up period with 468,190 dementia-free controls. Demographic and health-related factors were also considered in the analysis.
Both strong opioids like oral morphine and oxycodone and weaker opioids such as tramadol were included. Interestingly, even exclusive use of weak opioids was tied to elevated dementia risk, with incidence rates ranging from 15% higher for younger groups to 7% higher for the oldest cohort studied.
While the study provides important insights into the potential cognitive risks of long-term opioid use, its observational nature means causality cannot be confirmed. Dr Pourhadi emphasised the need for further research, stating, “Our study can’t infer causality, but I hope it inspires deeper exploration into the long-term effects opioids may have on cognition and dementia.”
The authors acknowledged certain limitations, including the absence of data on opioid use before 1995 and the lack of information on the severity or duration of chronic pain suffered by participants. They also noted that the cumulative opioid exposure measured may have been underestimated.
These findings add to the ongoing discussion about how opioids affect people in the long run, especially since they’re widely used to treat long-term pain that isn’t caused by cancer. As concerns grow about the health problems linked to opioids, this study shows why it’s important to be careful when prescribing them and to do more research into how they might affect the brain.
Source: MEDPAGETODAY
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