{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T16:25:41Z","timestamp":1790007941294,"version":"4.0.1"},"reference-count":31,"publisher":"Wiley","issue":"8","license":[{"start":{"date-parts":[[2015,8,20]],"date-time":"2015-08-20T00:00:00Z","timestamp":1440028800000},"content-version":"vor","delay-in-days":19,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["R03AG042930"],"award-info":[{"award-number":["R03AG042930"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["U01AG006781"],"award-info":[{"award-number":["U01AG006781"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J American Geriatrics Society"],"published-print":{"date-parts":[[2015,8]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>To determine whether prescription opioid use is associated with higher dementia risk or greater cognitive decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>Prospective cohort study.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Setting<\/jats:title>\n                    <jats:p>Group Health, an integrated healthcare delivery system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Community\u2010dwelling individuals aged 65 and older without dementia with at least 10\u00a0years of Group Health enrollment at baseline (N\u00a0=\u00a03,434; median age 74).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Measurements<\/jats:title>\n                    <jats:p>The Cognitive Abilities Screening Instrument (CASI) was administered every 2\u00a0years. Low scores triggered detailed evaluation, and a multidisciplinary committee assigned dementia diagnoses. From computerized pharmacy data, cumulative opioid exposure was defined as total standardized doses (TSDs) dispensed over 10\u00a0years (excluding the most recent year because of possible prodromal symptoms). For comparison, use of nonsteroidal anti\u2010inflammatory drugs (NSAIDs), characterized similarly, was examined. Dementia risk was analyzed using Cox proportional hazards models and CASI trajectory using linear regression models and generalized estimating equations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Seven hundred ninety\u2010seven participants (23%) developed dementia over a mean follow\u2010up of 7.3\u00a0years; 637 (19%) had possible or probable Alzheimer's disease. For cumulative opioid use, the hazard ratios (HRs) for dementia were 1.06 (95% confidence interval (CI)\u00a0=\u00a00.88\u20131.26) for 11 to 30 TSDs, 0.88 (95% CI\u00a0=\u00a00.70\u20131.09) for 31 to 90 TSDs, and 1.29 (95% CI\u00a0=\u00a01.02\u20131.62) for 91 or more TSDs, versus 0 to 10 TSDs. A similar pattern was seen for NSAID use. Heavier opioid use was not associated with more\u2010rapid cognitive decline.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>People with the heaviest opioid or NSAID use had slightly higher dementia risk than people with little or no use. These results may reflect an effect of chronic pain on cognition or residual confounding. Although opioids have other risks, little evidence of long\u2010term cognitive harm specific to opioids was found.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jgs.13562","type":"journal-article","created":{"date-parts":[[2015,8,20]],"date-time":"2015-08-20T04:29:16Z","timestamp":1440044956000},"page":"1519-1526","source":"Crossref","is-referenced-by-count":121,"title":["Prescription Opioids and Risk of Dementia or Cognitive Decline: A Prospective Cohort Study"],"prefix":"10.1111","volume":"63","author":[{"given":"Sascha","family":"Dublin","sequence":"first","affiliation":[{"name":"Group Health Research Institute Seattle Washington"},{"name":"Department of Epidemiology University of Washington Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rod L.","family":"Walker","sequence":"additional","affiliation":[{"name":"Group Health Research Institute Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shelly L.","family":"Gray","sequence":"additional","affiliation":[{"name":"School of Pharmacy University of Washington Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rebecca A.","family":"Hubbard","sequence":"additional","affiliation":[{"name":"Center for Clinical Epidemiology and Biostatistics Department of Biostatistics and Epidemiology Perelman School of Medicine University of Pennsylvania Philadelphia Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa L.","family":"Anderson","sequence":"additional","affiliation":[{"name":"Group Health Research Institute Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Onchee","family":"Yu","sequence":"additional","affiliation":[{"name":"Group Health Research Institute Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul K.","family":"Crane","sequence":"additional","affiliation":[{"name":"Division of General Internal Medicine Department of Medicine University of Washington Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric B.","family":"Larson","sequence":"additional","affiliation":[{"name":"Group Health Research Institute Seattle Washington"},{"name":"Division of General Internal Medicine Department of Medicine University of Washington Seattle Washington"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2015,8,20]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.5055\/jom.2008.0019"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.1833"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1526-4637.2011.01211.x"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcrc.2010.02.009"},{"key":"e_1_2_6_6_1","first-page":"575","article-title":"Delirium in older medical inpatients and subsequent cognitive and functional status: A prospective study","volume":"165","author":"McCusker J","year":"2001","journal-title":"Can Med Assoc J"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1093\/ageing\/28.6.551"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1093\/brain\/awq263"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2990.2005.00670.x"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneurol.2010.17"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0018190"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0028-3908(02)00030-8"},{"key":"e_1_2_6_13_1","doi-asserted-by":"publisher","DOI":"10.1001\/archneur.59.11.1737"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.1097\/AJP.0b013e318169d03b"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1532-5415.2011.03586.x"},{"key":"e_1_2_6_16_1","unstructured":"ATC\/DDD Index2014.World Health Organization Collaborating Centre for Drug Statistics Methodology [on\u2010line]. 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