A Clinical Study of the Cognitive Effects of Benzodiazepines in Psychogeriatric Patients

Abstract

Introduction:

Previous studies have shown cognitive impairment in long-term benzodiazepine users compared to non-users. However, little is known about such effects in a population of geriatric psychiatry patients. The aim of this study was to identify differences between benzodiazepine users and non-users on standardized tests of the cognitive fields of learning and memory, executive functions and vigilance, at admittance to a department of geriatric psychiatry.

Materials and Methods:

Hopkins verbal learning test, Stroop test and digit vigilance test were performed in all patients. Test performances were compared between benzodiazepine users (n=168) and non-users (n=73). A multiple linear regression model was used, adjusting for different baseline characteristics (years of education, dementia and depression).

Results:

No significant differences in test results were found between benzodiazepine users and non-users on 11 out of 12 cognitive tests results. On one of the 12 test results (time used on the digit vigilance test), benzodiazepine users showed better performance compared to non-users (β=−0.20, p=0.032). This finding was not statistically significant after Bonferroni correction for multiple testing.

Conclusion:

This study of geriatric psychiatry benzodiazepine users did not reveal cognitive impairment compared to non-users on the cognitive areas tested. Other possible negative consequences of benzodiazepine use should, however, also be considered when prescribing drugs to older patients.

Key words

elderly - geriatric psychiatry - drug use - benzodiazepines

• References

• 1 Roache JD, Griffiths RR. Comparison of triazolam and pentobarbital: performance impairment, subjective effects and abuse liability. J Pharmacol Exp Ther 1985; 234: 120-133
• 2 Evans SM, Funderburk FR, Griffiths RR. Zolpidem and triazolam in humans: behavioral and subjective effects and abuse liability. J Pharmacol Exp Ther 1990; 255: 1246-1255
• 3 Barker MJ, Greenwood KM, Jackson M et al. Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs 2004; 18: 37-48
• 4 Allard J, Artero S, Ritchie K. Consumption of psychotropic medication in the elderly: a re-evaluation of its effect on cognitive performance. Int J Geriatr Psychiatry 2003; 18: 874-878
• 5 Lagnaoui R, Tournier M, Moride Y et al. The risk of cognitive impairment in older community-dwelling women after benzodiazepine use. Age Ageing 2009; 38: 226-228
• 6 Pat MM, Weiss RT, Sandor P et al. Cognitive effects of long-term benzodiazepine use in older adults. Hum Psychopharmacol 2003; 18: 51-57
• 7 Puustinen J, Nurminen J, Lopponen M et al. Use of CNS medications and cognitive decline in the aged: a longitudinal population-based study. BMC Geriatr 2011; 11: 70
• 8 Puustinen J, Nurminen J, Kukola M et al. Associations between use of benzodiazepines or related drugs and health, physical abilities and cognitive function: a non-randomised clinical study in the elderly. Drugs Aging 2007; 24: 1045-1059
• 9 Verdoux H, Lagnaoui R, Begaud B. Is benzodiazepine use a risk factor for cognitive decline and dementia? A literature review of epidemiological studies. Psychol Med 2005; 35: 307-315
• 10 van VP, van der Mast RC, van den Broek M et al. Use of benzodiazepines, depressive symptoms and cognitive function in old age. Int J Geriatr Psychiatry 2009; 24: 500-508
• 11 Bierman EJ, Comijs HC, Gundy CM et al. The effect of chronic benzodiazepine use on cognitive functioning in older persons: good, bad or indifferent?. Int J Geriatr Psychiatry 2007; 22: 1194-1200
• 12 Foy A, O’Connell D, Henry D et al. Benzodiazepine use as a cause of cognitive impairment in elderly hospital inpatients. J Gerontol A Biol Sci Med Sci 1995; 50: M99-M106
• 13 Hanlon JT, Horner RD, Schmader KE et al. Benzodiazepine use and cognitive function among community-dwelling elderly. Clin Pharmacol Ther 1998; 64: 684-692
• 14 Paterniti S, Dufouil C, Alperovitch A. Long-term benzodiazepine use and cognitive decline in the elderly: the Epidemiology of Vascular Aging Study. J Clin Psychopharmacol 2002; 22: 285-293
• 15 Hoiseth G, Kristiansen KM, Kvande K et al. Benzodiazepines in geriatric psychiatry – what doctors report and patients actually use. Drugs Aging 2013; 30: 113-118
• 16 Brandt J, Benedict RHB. Hopkins verbal learning test – revised. Odessa, FL: Psychological Assessment Resources; 2001
• 17 Stroop J. Studies of interference in serial verbal reaction. J Exp Psychol 1935; 18: 643-662
• 18 Lewis LJ. Digit Vigilance Test: Professional users guide. Lutz, FL: Psychological Assessment Resources; 1995
• 19 Streiner DL, Norman GR. Correction for multiple testing: is there a resolution?. Chest 2011; 140: 16-18
• 20 Neutel CI, Skurtveit S, Berg C. What is the point of guidelines? Benzodiazepine and z-hypnotic use by an elderly population. Sleep Med 2012; 13: 893-897
• 21 Bramness JG, Skurtveit S, Morland J. Clinical impairment of benzodiazepines – relation between benzodiazepine concentrations and impairment in apprehended drivers. Drug Alcohol Depend 2002; 68: 131-141
• 22 Glass J, Lanctot KL, Herrmann N et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 2005; 331: 1169
• 23 Landi F, Cesari M, Russo A et al. Benzodiazepines and the risk of urinary incontinence in frail older persons living in the community. Clin Pharmacol Ther 2002; 72: 729-734
• 24 Finkle WD, Der JS, Greenland S et al. Risk of fractures requiring hospitalization after an initial prescription for zolpidem, alprazolam, lorazepam, or diazepam in older adults. J Am Geriatr Soc 2011; 59: 1883-1890
• 25 Sylvestre MP, Abrahamowicz M, Capek R et al. Assessing the cumulative effects of exposure to selected benzodiazepines on the risk of fall-related injuries in the elderly. Int Psychogeriatr 2011; 1-10
• 26 Titler MG, Shever LL, Kanak MF et al. Factors associated with falls during hospitalization in an older adult population. Res Theory Nurs Pract 2011; 25: 127-148
• 27 Nurminen J, Puustinen J, Piirtola M et al. Psychotropic drugs and the risk of fractures in old age: a prospective population-based study. BMC Public Health 2010; 10: 396