Psychiatry research · 2026
Lithium versus valproate in bipolar disorder: Associations with dementia, mortality, suicide attempt, and end-stage renal disease in adults aged 45 years and older - a propensity score-matched retrospective cohort study.
СтатьяСравнительное исследованиеНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Changchien Te-Chang, Zul Danny Danilo, Cheng Kai-Da, Mathurin Tasha Verna, Dagbue Abigail Chinyere, Fang Yi-Ya, Liang Chih-Sung, Yeh Wei-Chiang, Hsu Tien-Wei
Аннотация
BACKGROUND/OBJECTIVE: Patients with bipolar disorder (BD) are at increased risk of dementia. However, few studies have directly compared subsequent dementia risk between BD patients treated with lithium and valproate, the two first-line mood stabilizers.
METHODS: This retrospective cohort study used the TriNetX collaborative network, which aggregates de-identified electronic health records across the United States. Adults aged≧45 years with BD who initiated lithium or valproate for the first time between 2000 and 2025 were included. 1:1 propensity score matching was applied. The primary outcome was all-cause dementia, and secondary outcomes were Alzheimer's disease, vascular dementia, unspecified dementia (ICD10 code: F03), mortality, suicide attempt, and ESRD.
RESULTS: After applying exclusion criteria and matching, 3056 patients remained in each group. Lithium use was associated with a lower risk of all-cause dementia than valproate use (207 [7.1%] vs 311 [10.8%]; Relative risk [RR], 0.658; 95% confidence interval [CI], 0.556-0.778; Hazard ratio [HR], 0.689; 95% CI, 0.578-0.822; both P<.001). Lithium use was also associated with lower risks of unspecified dementia (HR, 0.677; 95% CI, 0.530-0.865; P=.002) and suicide attempt (HR, 0.594; 95% CI, 0.399-0.885; P=.010). Although the relative risk of Alzheimer disease was lower in the lithium group, the adjusted hazard ratio did not reach statistical but marginal significance. No significant between-group differences were observed for vascular dementia, mortality, or ESRD.
LIMITATIONS: Residual confounding may persist due to the observational design, and dementia diagnoses relied on clinical coding within electronic health records.
CONCLUSIONS: In this large, compliance-verified cohort, lithium treatment was associated with lower risks of dementia compared to valproate, without excess ESRD or mortality risk. These findings support lithium as a preferred long-term mood stabilizer for preserving cognitive outcomes in older adults with bipolar disorder, though observational data preclude causality inferences.
METHODS: This retrospective cohort study used the TriNetX collaborative network, which aggregates de-identified electronic health records across the United States. Adults aged≧45 years with BD who initiated lithium or valproate for the first time between 2000 and 2025 were included. 1:1 propensity score matching was applied. The primary outcome was all-cause dementia, and secondary outcomes were Alzheimer's disease, vascular dementia, unspecified dementia (ICD10 code: F03), mortality, suicide attempt, and ESRD.
RESULTS: After applying exclusion criteria and matching, 3056 patients remained in each group. Lithium use was associated with a lower risk of all-cause dementia than valproate use (207 [7.1%] vs 311 [10.8%]; Relative risk [RR], 0.658; 95% confidence interval [CI], 0.556-0.778; Hazard ratio [HR], 0.689; 95% CI, 0.578-0.822; both P<.001). Lithium use was also associated with lower risks of unspecified dementia (HR, 0.677; 95% CI, 0.530-0.865; P=.002) and suicide attempt (HR, 0.594; 95% CI, 0.399-0.885; P=.010). Although the relative risk of Alzheimer disease was lower in the lithium group, the adjusted hazard ratio did not reach statistical but marginal significance. No significant between-group differences were observed for vascular dementia, mortality, or ESRD.
LIMITATIONS: Residual confounding may persist due to the observational design, and dementia diagnoses relied on clinical coding within electronic health records.
CONCLUSIONS: In this large, compliance-verified cohort, lithium treatment was associated with lower risks of dementia compared to valproate, without excess ESRD or mortality risk. These findings support lithium as a preferred long-term mood stabilizer for preserving cognitive outcomes in older adults with bipolar disorder, though observational data preclude causality inferences.