The DOI matches its Crossref record; 65 of the 65 references it cites were found in a registry or an index; 14 of the 41 sources its claims cite were checked for support.
Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors
Open accessAbstract
OBJECTIVE: Selective serotonin reuptake inhibitors (SSRIs) are the first line of treatment for depression. Among the SSRIs, paroxetine has strong anticholinergic properties and may lead to increased risk of adverse cognitive outcomes among elderly patients. This study evaluated the comparative risk of dementia associated with use of paroxetine and other SSRIs among elderly nursing home patients. METHODS: A retrospective cohort study using propensity score matching was conducted with 2007-2010 Minimum Data Set-linked Medicare data. The study population included elderly nursing home patients with depression who were new users of SSRIs. Patients were followed for a maximum of two years after index SSRI use. The risk of dementia was modeled by using a robust Cox proportional hazards model to account for clustering within matched users of paroxetine and other SSRIs. RESULTS: The unmatched cohort included 19,952 new users of SSRIs; 1,898 used paroxetine, and 18,054 used other SSRIs. In the propensity-matched cohort of 3,796 patients, the unadjusted incidence of dementia was 7.5% for users of paroxetine and 8.6% for users of other SSRIs. There was no difference in the risk of dementia for users of paroxetine or other SSRIs. These study findings remained robust in multiple sensitivity analyses involving various measures of dementia. CONCLUSIONS: Compared with use of other SSRIs, use of paroxetine was not associated with higher risk of dementia among elderly nursing home patients with depression. Future studies are needed to evaluate the impact of paroxetine on other cognition measures.
Overview
AI snapshot
Written from the paper’s full text.
TL;DR
In elderly nursing home patients with depression, new use of paroxetine was not associated with a higher risk of dementia compared with other SSRIs. The propensity-matched analysis found similar dementia incidence and no significant difference in risk.
Key findings
- The unmatched cohort included 19,952 new SSRI users: 1,898 paroxetine users and 18,054 users of other SSRIs.
- In the propensity-matched cohort of 3,796 patients (1,898 per group), the unadjusted incidence of dementia was 7.5% for paroxetine users and 8.6% for other SSRI users; there were 306 incident dementia cases.
- The robust Cox proportional hazards model showed no significant difference in dementia risk: HR=.99, 95% CI=.79–1.23, p=.896.
- Findings remained nonsignificant in sensitivity analyses: first sensitivity analysis HR=.98, 95% CI=.79–1.22, p=.862; second sensitivity analysis HR=1.18, 95% CI=.84–1.66, p=.337.
Methods
- Retrospective cohort study using 2007–2010 Minimum Data Set–linked Medicare data, including elderly nursing home patients age 65 or older with depression who were new users of SSRIs between January 1, 2008, and December 31, 2008, without baseline dementia.
- Patients were followed for a maximum of two years after index SSRI use; exposure was classified as paroxetine versus other SSRIs (sertraline, citalopram, fluoxetine, fluvoxamine, escitalopram).
- Propensity score matching used more than 70 covariates and a GREEDY 5→1 technique; dementia risk was modeled with a robust Cox proportional hazards model to account for clustering within matched pairs, with additional sensitivity analyses.
Limitations
- Stated in the paper: disease and outcome measurements relied on diagnostic claims data; pharmacy claims captured dispensing but not actual use; medications in Part A bundled payments for short postacute nursing home stays were not captured; Medicare secondary data may have miscoding and undercoding; unmeasured factors such as apolipoprotein E-e4, other genetic factors, diet, physical activity, stress, smoking, and alcohol consumption were unavailable; propensity score approaches control only for observed confounders, so unobserved confounding may affect findings.
- Evident from the text: the study is observational and residual confounding cannot be excluded; dementia ascertainment via claims/MDS may misclassify cases; follow-up was limited to a maximum of two years; the cohort was restricted to fee-for-service Medicare nursing home residents, which may limit generalizability.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
14 of 41 cited sources checked · 8 supported · 0 flagged · accuracy not yet measured
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Paroxetine was found to have higher affinity for muscarinic acetylcholine receptors compared with other SSRIs (20,21).”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Supportedcites [20] source
The section on pharmacological mechanisms beyond SERT inhibition reports a lower M1 muscarinic receptor Ki for paroxetine (72 nmol/l) than for the other SSRIs compared, sertraline (430 nmol/l) and escitalopram (1240 nmol/l). This supports the stated higher affinity; page numbers were not provided in our copy. (LLM, conf=0.92)
- Not checked — no full text of the sourcecites [21] Owens MJ, 1997, Journal of Pharmacology and Experimental Therapeutics source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“Among the SSRIs, paroxetine has strong anticholinergic properties and may lead to increased risk of adverse cognitive outcomes among elderly patients.”
- Also stated in: § DISCUSSION · plain
“Among the SSRIs, paroxetine is highly anticholinergic and can lead to adverse cognitive effects.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Supportedcites [20] source
The section on pharmacological mechanisms beyond SERT inhibition describes paroxetine as having considerable potency at muscarinic receptors and reports anticholinergic effects in vivo. This supports the attributed claim that its anticholinergic properties are strong relative to the other SSRIs compared. (LLM, conf=0.92)
- Not checked — no full text of the sourcecites [21] Owens MJ, 1997, Journal of Pharmacology and Experimental Therapeutics source
Load-bearingStrength:boosted· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § DISCUSSION · plain
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Another longitudinal study, the Indianapolis-Ibadan dementia project, revealed that number of anticholinergics was associated with an increased risk of cognitive impairment (OR=1.46,CI=1.07-1.99)(12).”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Partly supportedcites [12] sourceExperimental — accuracy not yet measured
The Results report the stated OR and CI for the number of definite anticholinergics, not anticholinergics generally. The Methods specify that this analysis of the Indianapolis-Ibadan Dementia Project was limited to African American participants in Indianapolis. (LLM, conf=0.87)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
The sources with a verdict support this claim; the rest weren’t checked yet, have no full text we could read, or their verdicts aren’t rated yet.
In the paper
“This model has been found to yield a hazard ratio (HR) with minimal bias compared with other propensity score-matched Cox models (44,45).”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Statistical Analysis
What the sources say
- Supportedcites [44] source
The Monte Carlo simulation results (Section 3.2) report minimal bias for the robust Cox model when estimating marginal hazard ratios in propensity-score-matched samples. The naïve matched Cox model had the same relative bias, while the model stratified on matched pairs had substantially greater bias; the robust model was not uniquely least biased. (LLM, conf=0.93)
- Not checked — no full text of the sourcecites [45] source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Carrière and others (13) found that the use of anticholinergic medications in a prospective cohort of elderly patients was associated with cognitive decline during a follow-up period of four years.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Supportedcites [13] source
The Discussion describes a large prospective study of community-dwelling elderly people and reports an increased risk of cognitive decline among those taking anticholinergics. The section ‘Associations between anticholinergics and cognitive decline over 4-year follow-up’ reports higher risks for continuing users than for nonusers; the association was not significant for those who discontinued use. (LLM, conf=0.94)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Previous literature suggests a strong association between anticholinergic use and risk of cognitive decline and dementia (12)(13)(14).”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Partly supportedcites [12] sourceExperimental — accuracy not yet measured
The Discussion (page not provided) says definite anticholinergics may increase the risk of less severe cognitive impairment. It also says this study found no association with incident dementia, so the cited paper does not support the claim of a strong association with dementia. (LLM, conf=0.90)
- Supportedcites [13] source
The Discussion reports an increased risk of cognitive decline and dementia among community-dwelling elderly people using anticholinergics, significant after adjustment. The Dementia section also reports a significant association between baseline use and incident dementia at four years. These passages support the citing sentence’s suggested association. (LLM, conf=0.90)
- Not checked yetcites [14] Campbell N, 2009, Clinical Interventions in Aging
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no association between risk of dementia and use of paroxetine or other SSRIs.”
- Also stated in: § CONCLUSIONS · plain
“This retrospective study using propensity score matching found no difference in the risk of dementia associated with paroxetine compared with other SSRIs among elderly nursing home residents with depression.”
- Also stated in: § CONCLUSIONS · plain
“Propensity score-matched PH model b | 1,898 | 1,898 | .99 | .79-1.23 | .896”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § CONCLUSIONS · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In the propensity-matched cohort of 3,796 patients, the unadjusted incidence of dementia was 7.5% for users of paroxetine and 8.6% for users of other SSRIs.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
Strength:plain· not yet calibratedn = 3,796Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There was no difference in the risk of dementia for users of paroxetine or other SSRIs.”
- Also stated in: § Abstract · plain
“Compared with use of other SSRIs, use of paroxetine was not associated with higher risk of dementia among elderly nursing home patients with depression.”
- Also stated in: § Risk of Dementia · plain
“The analysis revealed that there was no significant difference in risk of dementia between paroxetine users and users of other SSRIs.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Also stated in: § Abstract · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were 306 incident cases of dementia in the matched cohort during the follow-up period.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Risk of Dementia
Strength:plain· not yet calibratedn = 306Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- Probably not a substantial claim. 21
- It may state two separate claims as one. 8
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Although paroxetine is highly anticholinergic, it is commonly used for the treatment of depression among elderly patients (23)(24)(25).”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Not checked — no full text of the sourcecites [23] source
- Partly supportedcites [24] sourceExperimental — accuracy not yet measured
The Results report paroxetine use in 8.38% of elderly nursing home residents with depression and list it among the most commonly prescribed level 2 anticholinergics. The study does not establish that paroxetine was prescribed to treat their depression, and its population is narrower than elderly patients generally. (LLM, conf=0.84)
- Partly supportedcites [25] sourceExperimental — accuracy not yet measured
The Results report that 1,716 of 19,050 elderly nursing home residents with depression who used SSRIs received paroxetine, supporting its use for depression in that population. The Objectives also describe its strong anticholinergic properties. The study does not establish how commonly paroxetine is used among elderly patients generally, beyond the nursing home cohort. (LLM, conf=0.84)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
Every source the paper cites for this claim was checked and supports it.
In the paper
“Studies suggest that paroxetine is a muscarinic antagonist and has a less favorable tolerability profile compared with escitalopram (20).”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Supportedcites [20] source
The pharmacological-mechanisms section identifies paroxetine’s antagonistic activity at cholinergic M1 muscarinic receptors. The tolerability section reports more sexual-dysfunction adverse events and discontinuation symptoms with paroxetine than with escitalopram; the Conclusion also describes escitalopram as having a tolerability advantage. (LLM, conf=0.94)
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“The American Geriatrics Society (22) considers use of paroxetine for patients with impaired cognition to be potentially inappropriate because of the drug's strong anticholinergic properties.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Partly supportedcites [22] sourceExperimental — accuracy not yet measured
The Results (page unavailable) say the criteria include a list of medications to avoid in older adults because they have strong anticholinergic properties. However, the passages in our copy do not identify paroxetine on that list or state a recommendation specifically for patients with impaired cognition (searched: paroxetine; dementia or cognitive impairment). (LLM, conf=0.76)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“A high risk of incident dementia was also observed among continuous users of anticholinergics (hazard ratio [HR]=1.65,CI=1.00-2.73)but not among those who discontinued the medications.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Supportedcites [13] source
The section on baseline anticholinergic use and four-year dementia incidence reports increased incident dementia risk among continuous users (HR=1.65, CI=1.00–2.73), but not among those who discontinued. Table 4 gives the discontinuing group's HR as 1.28 (CI=0.59–2.76). (LLM, conf=0.95)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“This utilization pattern is consistent with the findings from previous studies (23)(24)(25).”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
What the sources say
- Not checked — no full text of the sourcecites [23] source
- Supportedcites [24] source
The Results report a utilization pattern among elderly nursing home residents with depression, including 95.85% overall anticholinergic use and nearly 62% use of medications with significant anticholinergic properties. This source is a previous study reporting the kind of findings the citing sentence invokes; the sentence specifies no narrower pattern to compare. (LLM, conf=0.85)
- Partly supportedcites [25] sourceExperimental — accuracy not yet measured
The Results (p. A209) report a utilization distribution: 9.01% of SSRI users received paroxetine and 90.99% received other SSRIs. The cited sentence does not specify what “this utilization pattern” is, so the source supports a prior pattern of SSRI use but does not establish that the two patterns are consistent. (LLM, conf=0.72)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Among new users of SSRIs, around 9% initiated treatment with paroxetine.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The unmatched cohort included 19,952 new users of SSRIs; 1,898 used paroxetine, and 18,054 used other SSRIs.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, multiple sensitivity analyses supported the main findings.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Thus paroxetine-induced anticholinergic side effects can increase the risk of dementia, especially among elderly persons with depression, who are already at risk of cognitive impairment.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
None of the sources cited for this claim have been checked yet.
In the paper
“Selective serotonin reuptake inhibitors (SSRIs) and selective norepinephrine reuptake inhibitors are considered first-line agents for treatment of depression (15,16).”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Not checked — no full text of the sourcecites [15] Alexopoulos GS, 2001, Postgraduate Medicine
- Not checked yetcites [16] Salzman C, 2005
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“A recent report by the Agency for Healthcare Research and Quality (11) found increased risk of cognitive decline among depressed patients; the report was based on 13 studies with a follow-up of 1.5 to 5.6 years.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Not matchedcites [11]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Not matched
In the paper
“This study used Medicare files, which are secondary data and thus have limitations due to miscoding and undercoding (56).”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
What the sources say
- Not checked — no full text of the sourcecites [56] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“The diseases and outcome measurements were based on diagnostic data in medical claims.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“This study evaluated comparative safety of paroxetine and other SSRIs in the vulnerable population of nursing home residents with depression by implementing a new-user design.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Ownby and colleagues (8) found that having depression was associated with significantly higher odds of Alzheimer's disease in case-control (odds ratio [OR]=2.0)and cohort (OR=1.9)studies.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Not checked — no full text of the sourcecites [8] source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Use of medications as a component of Part A bundled payments for short postacute nursing home stays was not captured.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Owen and others (21) found that paroxetine's muscarinic binding was similar to that of desipramine but much lower compared with amitriptyline and substantially higher compared with sertraline.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Not checked — no full text of the sourcecites [21] Owens MJ, 1997, Journal of Pharmacology and Experimental Therapeutics source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“A recent comparative-effectiveness review found that secondgeneration antidepressants do not substantially differ from each other in terms of efficacy (17).”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Not checked — no full text of the sourcecites [17] source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“There is a chance that unobserved confounding can affect study findings.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
- Rests on an assumption: Propensity score approaches control only for observed confounders.
In the paper
“In addition, a meta-analysis by Christensen and colleagues (10) revealed that depressive patients had low performance on almost all cognitive tests.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Not checked — no full text of the sourcecites [10] source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Also, the pharmacy claims captured only dispensing data and not actual use by patients.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In addition, this study had several advantages compared with randomized trials, such as a large sample size of elderly patients, a long follow-up period, and real-world data.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Unlike previous studies that examined all anticholinergics, this study focused on persons who were treated with SSRIs to evaluate the comparative risk and thus minimized indication bias.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
In the paper
“Goodnick and Goldstein (19) suggested that all SSRIs except paroxetine are devoid of anticholinergic properties.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > Abstract
What the sources say
- Not checked — no full text of the sourcecites [19] source
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Long-term exposure to SSRIs was ascertained by using Part D claims data.”
§ Risk of Dementia Among Elderly Nursing Home Patients Using Paroxetine and Other Selective Serotonin Reuptake Inhibitors > DISCUSSION
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
The paper relies on this without support.
No previous studies have examined paroxetine use and the risk of dementia among elderly patients with depression, especially in nursing homes.
“None of the previous studies have examined paroxetine use and the risk of dementia among elderly patients with depression, especially in nursing homes.”
The paper relies on this without support.
This is the first study to establish that paroxetine does not increase the risk of dementia among elderly nursing home residents with depression compared with other SSRIs.
“This is the first study, to our knowledge, to establish that paroxetine, although highly anticholinergic, does not increase the risk of dementia among elderly nursing home residents with depression compared with other SSRIs.”
The paper relies on this without support.
Propensity score matching adequately controls for confounding, including unmeasured confounders, so that the matched groups differ only on treatment assignment.
“Propensity score matching is commonly used to minimize pretreatment differences between two groups such that the matched groups differ only on treatment assignment.”
The paper relies on this without support.
Propensity score approaches control only for observed confounders.
“approaches control only for observed confounders.”
The paper relies on this without support.
Paroxetine has stronger anticholinergic properties compared with other SSRIs.
“Although paroxetine has stronger anticholinergic properties compared with other SSRIs”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Glaucoma percentage is too high for the reported count
MinorBoth paroxetine columns report 393 patients with glaucoma as 24%; among 1,898 patients, that is about 20.7%, or 21% to the nearest whole percent.
Reported 24 · recomputed 20.706006
“| Glaucoma | 393 | 24 | 4,268 | 24 | .004 | 393 | 24 | 390 | 21 | .904 |”
Insomnia percentage is too high for the reported count
MinorBoth paroxetine columns list 50 patients with insomnia as 4% of 1,898; the percentage is about 2.6%, or 3% to the nearest whole percent.
Reported 4 · recomputed 2.634352
“| Insomnia | 50 | 4 | 513 | 3 | .604 | 50 | 4 | 61 | 3 | .289 |”
Matched drug-dependence-agent percentage is understated
MinorThe matched columns report 11 users as .1% of each 1,898-person group. Eleven of 1,898 is about .58%, not .1%.
Reported 0.1 · recomputed 0.579557
“| Alcohol and drug dependence agent | 11 | 1 | 204 | 1 | .027 | 11 | .1 | 11 | .1 | .584 |”
Citations
Cites
Journal of Clinical Psychiatry
(2018) · Journal of Clinical Psychiatry · doi:10.5505/kpd · Cited by 13,703
A JOURNAL OF PHARMACOLOGY AND EXPERIMENTAL THERAPEUTICS
Lindemann, L., Jaeschke, G., Michalon, A., Vieira, E., Honer, M., Spooren, W., Porter, R., Hartung, T., Kolczewski, S., Büttelmann, B., et al. (1909) · JAMA · doi:10.1001/jama.1909.02550020033007 · Cited by 7,889
Forecasting the global burden of Alzheimer's disease
Brookmeyer, R., Johnson, E., Ziegler‐Graham, K., & Arrighi, H. M. (2007) · Alzheimer's & Dementia · doi:10.1016/j.jalz.2007.04.381 · Cited by 3,370
The American Journal of Managed Care
(2020) · The American Journal of Managed Care · doi:10.37765/ajmc · Cited by 3,254
The Robust Inference for the Cox Proportional Hazards Model
Lin, D. Y., & Wei, L. J. (1989) · Journal of the American Statistical Association · doi:10.1080/01621459.1989.10478874 · Cited by 2,695
The American Geriatrics Society 2012 Beers Criteria Update Expert Panel (2012) · Journal of the American Geriatrics Society · doi:10.1111/j.1532-5415.2012.03923.x · Cited by 2,578
Fick, D. M., Cooper, J. W., Wade, W. E., Waller, J. L., Maclean, J. R., & Beers, M. H. (2003) · Archives of Internal Medicine · doi:10.1001/archinte.163.22.2716 · Cited by 2,389
Variable Selection for Propensity Score Models
Brookhart, M. A., Schneeweiss, S., Rothman, K. J., Glynn, R. J., Avorn, J., & Stürmer, T. (2006) · American Journal of Epidemiology · doi:10.1093/aje/kwj149 · Cited by 2,336
Medication compliance and persistence: terminology and definitions
Cramer, J. A., Roy, A., Burrell, A., Fairchild, C. J., Fuldeore, M. J., Ollendorf, D. A., & Wong, P. K. (2008) · Value in Health · doi:10.1111/j.1524-4733.2007.00213.x · Cited by 2,220
Explicit Criteria for Determining Potentially Inappropriate Medication Use by the Elderly
Beers, M. H. (1997) · Archives of Internal Medicine · doi:10.1001/archinte.157.14.1531 · Cited by 1,568
Flagged first, then by citations
Research works printed but not linked: 1
- 2011, SAS 9.3 Guide to Software Updates
Cited by
Sorted by citations
Pieper, N. T., Grossi, C. M., Chan, W.-Y., Loke, Y. K., Savva, G. M., Haroulis, C., Steel, N., Fox, C., Maidment, I. D., Arthur, A. J., et al. (2020) · Age and Ageing · doi:10.1093/ageing/afaa090 · Cited by 138
Chan, J. Y. C., Yiu, K. K. L., Kwok, T. C. Y., Wong, S. Y. S., & Tsoi, K. K. F. (2019) · Journal of the American Medical Directors Association · doi:10.1016/j.jamda.2018.12.004 · Cited by 135
Anticholinergic medication use and dementia: latest evidence and clinical implications
Gray, S. L., & Hanlon, J. T. (2016) · Therapeutic Advances in Drug Safety · doi:10.1177/2042098616658399 · Cited by 82
The cognitive effect of anticholinergics for patients with overactive bladder
Welk, B. K., Richardson, K., & Panicker, J. N. (2021) · Nature Reviews Urology · doi:10.1038/s41585-021-00504-x · Cited by 75
Mawanda, F., Wallace, R. B., McCoy, K. D., & Abrams, T. E. (2017) · Journal of the American Geriatrics Society · doi:10.1111/jgs.14756 · Cited by 73
Metadata
- Authors
- Bali, V., Chatterjee, S., Carnahan, R. M., Chen, H., Johnson, M. L., & Aparasu, R. R.
- Affiliations
- University of Iowa (US)
- Venue
- Psychiatric Services
- Published
- 2015-12-01
- Volume
- 66
- Issue
- 12
- Pages
- 1333-1340
- ISSN
- 0022-1597 (ISSN-L)
- 1075-2730
- 1557-9700
- OpenAlex
- W1896306650
- Semantic Scholar
- 7e1a35188c6b3cf95171142c8644644f3e1ca327
- Cited by
- 23
- References
- 59
- Citations by year
- 2025: 2 · 2024: 1 · 2023: 2 · 2022: 1 · 2021: 3 · 2020: 2 · 2019: 2 · 2018: 3 · 2017: 3 · 2016: 3 · 2015: 1
- FWCI
- 2.26
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Psychiatric Services (publishedVersion)
- PubMed (publishedVersion)
- Funders
- Agency for Healthcare Research and Quality (R01HS021264)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Dementia and Cognitive Impairment Research
- Health Sciences › Medicine › Pharmacology (medical) › Treatment of Major Depression
- Health Sciences › Medicine › Geriatrics and Gerontology › Pharmaceutical Practices and Patient Outcomes
- Keywords
- paroxetine, selective serotonin reuptake inhibitors, dementia risk, nursing home residents, elderly patients, depression, anticholinergic effects, cognitive outcomes, antidepressant side effects
- MeSH terms
- Aged, Aged, 80 and over, Dementia, Depressive Disorder, Female, Homes for the Aged, Humans, Male, Nursing Homes, Retrospective Studies, Risk, United States, Cohort Studies, Comorbidity, Causality, Proportional Hazards Models, Selective Serotonin Reuptake Inhibitors, Paroxetine
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-11-07, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-11-07 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
