Use of benzodiazepines and related drugs is associated with a risk of stroke among persons with Alzheimer’s disease

The aim of our study was to investigate the risk of any, ischemic, and hemorrhagic stroke associated with incident benzodiazepine and related drug (BZDR) use among community-dwelling individuals with Alzheimer's disease (AD). Data from the MEDALZ cohort including all community-dwelling persons newly diagnosed with AD between 2005 and 2011 in Finland were utilized. Incident BZDR users were identified with a 1-year washout period for previous use. Persons with a previous stroke were excluded, resulting in a final study sample of 45 050 individuals. Incident any, ischemic, and hemorrhagic strokes were identified from the Hospital Discharge and Causes of Death registers. The risk of stroke between time on BZDRs was compared with nonuse time with Cox proportional hazard models. During the follow-up, 21.9% (N=9879) of persons started BZDR use. Compared with nonuse, BZDR use was associated with an increased risk of any stroke [adjusted hazard ratio (aHR): 1.21; 95% confidence interval (CI): 1.04-1.40] and ischemic stroke (aHR: 1.21; 95% CI: 1.02-1.44), but the association between BZDR use and hemorrhagic stroke did not reach significance (aHR: 1.26; 95% CI: 0.91-1.74). Z-drug use was associated with a similar risk as benzodiazepine use. In conclusion, BZDR use was associated with an increased risk of stroke among older individuals with AD.