Prescription of Benzodiazepines and Related Drugs in Patients with Mild Cognitive Deficits and Alzheimer’s Disease

Heßmann, Philipp; Dodel, Richard; Baum, Erika; Müller, Matthias J.; Paschke, Greta; Kis, Bernhard; Zeidler, Jan; Klora, Mike; Reese, Jens‐Peter; Balzer‐Geldsetzer, Monika

doi:10.1055/s-0044-100523

Cited by 11 publications

(13 citation statements)

References 31 publications

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“…Previous studies of BZD plus ADep use have found a high probability of combined use when one of the drugs have already been prescribed, 20,45,46 and with higher rates of prescription. 46,47 Commonly these medications are prescribed without a clear indication based on formal diagnosis, lack of a comprehensive geriatric assessment, and inadequate adherence to updated recommendations for prescription in older adults with dementia.…”

Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 98%

“…, 19 Thus, they should be carefully managed and preferably avoided particularly in individuals with high comorbidity, frailty, and dementia 14 . The evidence regarding the ADep benefits in mood symptoms in people with dementia is mixed and the data are difficult to interpret because of small sample sizes, heterogeneity, and use of multiple outcome measures 20 . But, ADep especially in older adults could also enhance the risk of adverse events, such as falls 16 …”

Section: Introductionmentioning

confidence: 99%

“…14 The evidence regarding the ADep benefits in mood symptoms in people with dementia is mixed and the data are difficult to interpret because of small sample sizes, heterogeneity, and use of multiple outcome measures. 20 But, ADep especially in older adults could also enhance the risk of adverse events, such as falls. 16,21 Despite this, long-term prescription of BZD, alone or in combination with another psychotropic drug such as ADep is common in clinical practice, including in the Nordic countries.…”

Section: Introductionmentioning

confidence: 99%

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Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia

Borda

Jaramillo‐Jimenez

Oesterhus

et al. 2021

Int J Geriat Psychiatry

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Objectives We aim to study the effects of the prescription of benzodiazepines and antidepressants on cognitive and functional decline in older adults living with Alzheimer's disease (AD) and Lewy body dementia (LBD) over a 5‐year follow‐up. Methods This is a longitudinal analysis of a Norwegian cohort study entitled “The Dementia Study of Western Norway” (DemVest). We included 196 patients newly diagnosed with AD (n = 111) and LBD (n = 85), followed annually for 5 years. Three prescription groups were defined: only benzodiazepines (BZD), only antidepressants (ADep), and the combination of benzodiazepines and antidepressants (BZD‐ADep). Linear mixed‐effects models were conducted to analyze the effect of the defined groups on the outcomes. The outcomes were functional decline, measured by the Rapid Disability Rating Scale—2, and cognition measured with the Mini‐Mental State Examination. Results Prescription of the combination of benzodiazepines and antidepressants in LBD was associated with faster functional decline. In AD, the prescription of BZD and BZD‐ADep was associated with greater functional deterioration. ADep alone did not show positive or negative significant associations with the studied outcomes. Conclusions BZD and especially the combination of BZD and ADep are associated with functional decline in AD and LBD and should be used cautiously.

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Section: Discussionmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia

Borda

Jaramillo‐Jimenez

Oesterhus

et al. 2021

Int J Geriat Psychiatry

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“…We conducted subgroup analyses of BZD abusers (Figure 3). Seven studies included participants with BZD abuse (38,40,41,43,45,47,48) (Table 1). In the BZD abuse subgroup, the abusers received significantly lower MMSE scores compared to the controls (n=7726; SMD: -0.23, 95% CI: -0.44 to -0.03, I² = 86%, p =0.02).…”

Section: Benzodiazepine Abuse and Cognitive Decline In The Eldersmentioning

confidence: 99%

The Effects of Benzodiazepine Use and Abuse on Cognition in the Elders: A Systematic Review and Meta-Analysis of Comparative Studies

et al. 2020

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Objective: Benzodiazepines (BZD) are one of the most frequently prescribed drugs worldwide. However, the cognitive effects of benzodiazepines in the elderly are highly debated. This systematic review and meta-analysis aims to explore the following two questions in the elderly population: (i) Do BZD lead to any impairments in cognitive functions in elderly users? and (ii) Which specific cognitive domains are most affected by BZD use and abuse? Methods: First, we performed a literature search following the PRISMA guidelines. Electronic databases, including PubMed, PsycINFO, EMBASE, Cochrane Library, and Web of Science were searched until May 14 th , 2020. After selecting the relevant articles, we integrated the results of the selected studies with a standardized cognitive classification method. Next, we performed meta-analyses with the random-effects model on the cognitive results. Finally, we specifically examined the cognitive impairments of BZD in the abuse subgroup. Results: Of the included studies, eight of the thirteen had meta-analyzable data. Compared to the controls, elderly BZD users had significantly lower digital symbol test scores (n=253; SMD:-0.61, 95% CI:-0.91 to 0.31, I² = 0%, p < 0.0001). There was no significant difference in Mini-Mental State Examination, Auditory Verbal Learning Test, and Stroop Color and Word Test scores between BZD users and controls. According to the subgroup analyses, BZD abusers performed significantly worse than controls in Mini-Mental State Examination (n=7726; SMD:-0.23, 95% CI:-0.44 to-0.03, I² = 86%, p = 0.02), while there was no significant difference between the regular BZD users and the controls (n=1536; SMD:-0.05, 95% CI:-0.59 to 0.48, I² = 92%, p =0.85). Conclusion: In the elderly population, the processing speed (digital symbol test scores) was significantly impaired in BZD users; global cognition (Mini-Mental State Examination scores) was significantly impaired in BZD abusers but not in BZD regular users. This study

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Factors associated with cognitive function in patient with Alzheimer's disease with newly prescribed acetylcholinesterase inhibitors: A 1‐year retrospective cohort study

Ching,

Chang,

Pan

et al. 2024

Aging Medicine

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ObjectiveWe aimed to examine the factors associated with treatment outcomes in patients with Alzheimer's disease (AD) after 1 year of acetylcholinesterase inhibitors (AChEI) treatment.MethodWe obtained electronic medical records from a medical center in Southern Taiwan between January 2015 and September 2021. Participants aged ≥60 who were newly diagnosed with AD and had been prescribed AChEIs were included. Cognitive assessments were performed before the AChEIs were prescribed and at the 1 year follow‐up. Cognition progressors were defined as a Mini‐Mental State Examination decline of >3 or a Clinical Dementia Rating decline of ≥1 after 1 year of AChEI treatment. The relationship between the baseline characteristics and cognitive status after follow‐up was investigated using logistic regression analysis after adjusting for potential confounders.ResultsA total of 1370 patients were included in our study (mean age, 79.86 ± 8.14 years). After adjustment, the body mass index (BMI) was found to be significantly lower in the progressor group [adjusted odds ratio (AOR): 0.970, 95% confidence intervals (95% CIs): 0.943 to 0.997, P = 0.033]. The usage of antipsychotics was significantly higher in the progressor group (AOR: 1.599, 95% CIs: 1.202 to 2.202, P = 0.001). The usage of benzodiazepine receptor agonists also tended to be significantly higher in the progressor group (AOR: 1.290, 95% CIs: 0.996 to 1.697, p = 0.054).ConclusionThese results suggest that patients with AD who receive 1 year of AChEI treatment and have a lower BMI or concurrent treatment with antipsychotics and benzodiazepine receptor agonists are more likely to suffer from cognitive decline.

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Prescription of Benzodiazepines and Related Drugs in Patients with Mild Cognitive Deficits and Alzheimer’s Disease

Abstract: The inappropriate use of BZDR conflicts with national and international guidelines. We suggest evaluating indications and treatment duration and improving the knowledge of alternative therapies in healthcare institutions.

Cited by 11 publications

References 31 publications

Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia

Benzodiazepines and antidepressants: Effects on cognitive and functional decline in Alzheimer's disease and Lewy body dementia

The Effects of Benzodiazepine Use and Abuse on Cognition in the Elders: A Systematic Review and Meta-Analysis of Comparative Studies

Factors associated with cognitive function in patient with Alzheimer's disease with newly prescribed acetylcholinesterase inhibitors: A 1‐year retrospective cohort study

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