Influence of Long-Term Benzodiazepine use on Neurocognitive Skills Related to Driving Performance in Patient Populations: A Review

Abstract

Acute benzodiazepine intoxication produces severe impairment of neurocognitive skills related to driving. It is less clear whether such impairments also occur in patients who use benzodiazepines chronically. The current review evaluated neurocognitive skills of long-term benzodiazepine users and addressed 2 major questions: do long-term users develop tolerance for the impairing effects of benzodiazepines on neurocognitive performance, and if so, does tolerance warrant a change in driver fitness classification systems that currently deem users of benzodiazepines unfit to drive? Neurocognitive impairments were reported in patients who on average used benzodiazepines for 5–15 years. In addition, sensitivity to acute benzodiazepine impairment decreased in long-term users, suggesting (partial) tolerance. Definitions of clinical relevance of neurocognitive impairments in long-term users and how these were affected by duration of benzodiazepine use were generally lacking. Also, sensitivity of neurocognitive tasks to drug effects and their validity to predict fitness to drive were generally unknown. Because of these limitations, no firm conclusion can be drawn regarding a re-classification of long-term benzodiazepine effects on driver fitness.

Driving performance and neurocognitive skills of long‐term users of benzodiazepine anxiolytics and hypnotics

“…Contrary to the absence of driving impairment, patients who used hypnotics longer than 3 years showed relevant impairment in some tests (i.e., the PVT, DSST, and DT). This finding seems in line with recent reviews (Crowe & Stranks, 2017;van der Sluiszen, Vermeeren, Jongen, Vinckenbosch, & Ramaekers, 2017) concluding that long-term treatment with benzodiazepines can be associated with deleterious neuropsychological effects. Impairment was even found to persist following benzodiazepine withdrawal (Crowe & Stranks, 2017 hypnotic use is comparable with, or larger than, the effects found for alcohol at a BAC of 0.5 mg/ml.…”

Detoxification Improves Multidomain Cognitive Dysfunction in High-Dose Benzodiazepine Abusers

“…Long-term BZD use was reported to be associated with abnormalities in cognitive functions, including attention, memory and learning ( Boeuf-Cazou et al, 2011 ; Barker et al, 2004a ; Puustinen et al, 2014 ; Helmes and Østbye, 2015 ; Fond et al, 2018 ), and higher risk of delirium, cognitive decline, falls, fractures, injuries, and road accidents ( Finkle et al, 2011 ; van der Sluiszen et al, 2017 ; Kok et al, 2018 ; Picton et al, 2018 ; Wedmann et al, 2019 ). However, most of these reports were from people at higher risk of cognitive decline, such as elderly people ( Finkle et al, 2011 ; Helmes and Østbye, 2015 ; Picton et al, 2018 ), intensive care unit patients ( Kok et al, 2018 ), or patients with schizophrenia ( Fond et al, 2018 ), whereby separating side effects of BZDs from symptoms of aging or a pathological state may be troublesome.…”

Driving Behaviour in Depression: Findings from a Driving Simulator Study

“…The majority of studies on road accidents have focused on socio-demographic characteristics and general personality, as well as driving competence [11,12]. While a small number of research studies have examined driving performance in relation to depression and anxiety, their main focus is often on the effects of the drugs, especially antidepressants and benzodiazepines [7,10,13,14].…”