Long-Term Use of Benzodiazepines May Be Linked to Alzheimer’s

While research has shown an association between benzodiazepines and acute cognitive function, evidence for a link between the anxiolytic medications and an increased risk for certain neurocognitive disorders remains unclear.

Researchers from the University of Bordeaux in France and the University of Montreal conducted a study to investigate the relationship between the risk for Alzheimer’s disease (AD) and long-term exposure to benzodiazepines, as well as any potential dose-response relationship.

“Prevalence of [benzodiazepines] use among elderly patients is consistently high in developed countries … [ranging] from 7 percent to 43 percent,” noted the researchers. International guidelines recommend short-term use of the drug, mainly because of withdrawal symptoms that make discontinuation problematic; however, the study noted, use of benzodiazepines is often long term in older people.

“Somewhere along the way, the message got lost, and patients were allowed to use benzodiazepines for months and years,” said Mohit P. Chopra, M.D., a member of APA’s Council on Geriatric Psychiatry. Chopra, who was not involved with the study, told Psychiatric News that guidelines recommend that the anxiolytic and insomnia medicines are to be used on a daily basis for no longer than four to six weeks.

In 2012, the American Geriatric Society (AGS) updated its list of potentially inappropriate drugs for older adults to include benzodiazepines, precisely because of cognitive side effects—yet, AGS reported, almost 50 percent of older adults who have been prescribed benzodiazepines continue to use such drugs without any formal monitoring system to indicate how they are responding to the drugs.

In the current study, to highlight the potential consequences associated with long-term use of benzodiazepines on neurocognitive function in the elderly, the researchers gathered data from 1,796 people aged 66 and older with a first diagnosis for AD and 7,184 age-matched cognitively healthy controls. The study analyzed participants’ prescription and medical records dating back six years prior to the AD diagnosis.

The results, published in BMJ September 9, showed that use of benzodiazepines for three months or more was associated with an increased risk—up to 51 percent—for AD. The association increased even more with longer exposure. In addition, the use of long-acting forms of benzodiazepines increased risk for AD by 19 percent more than that of short-acting versions. The results were sustained after adjusting for anxiety, depression, and sleep disorders among the study subjects.

The researchers concluded that benzodiazepines are “indisputably valuable tools for managing anxiety disorders and transient insomnia,” but warned that treatment with these medications should be used within the time parameters set by international guidelines.

Davangere Devanand, M.D., director of the geriatric psychiatry program at Columbia University, agreed with this recommendation.

“These findings emphasize the importance of restricting the use of benzodiazepines in the elderly population,” said Devanand in an interview with Psychiatric News. “Benzodiazepines are known to be associated with an increased risk of worsening cognition … even in cognitively normal elderly subjects.” Devanand said that in such situation, it would be would be best to taper and cease patients’ use of the benzodiazepine while reevaluating cognition functioning. “If the cognitive decline is due to benzodiazepines, and the patient does not have an underlying dementia such as Alzheimer’s disease, the cognitive decline should reverse after stopping the treatment.”

Devanand stressed that in order to ensure that prescribers are not putting their patients at risk for the onset of neurocognitive disorders, “benzodiazepines should be prescribed sparingly and for short periods.” ■

An abstract of “Benzodiazepine Use and Risk of Dementia: Prospective Population-Based Study” can be accessed here.