The Association Between Dementia and Long-Term Use of Benzodiazepine in the Elderly: Nested Case–Control Study Using Claims Data

Wu, Chi‐Shin; Wang, Sheng-Chang; Chang, I‐Shou; Lin, Keh‐Ming

doi:10.1097/jgp.0b013e3181a65210

Cited by 129 publications

(116 citation statements)

References 31 publications

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“…This study found that prescribers do not pay attention to reduce the dosage according to existing recommendations, especially in patients treated for insomnia. We do not know whether this reluctance indirectly leads to a higher mortality [59], but several studies state the existence of adverse effects, such as cognitive impairment [14,15] addictive properties and possible withdrawal effects. The pharmaceutical companies should produce packages with appropriate dosages for older adults.…”

Section: Implications For Practice and Researchmentioning

confidence: 99%

“…Long-term use of benzodiazepines is discouraged in guidelines [5,7,8] because of the lack of effectiveness after 4 weeks [9,10], the increased risk of dependence and abuse, and withdrawal syndromes [11,12]. Moreover, it has been hypothesised that long-term use might have a detrimental effect on cognition and a potential acceleration of cognitive impairment [13][14][15].…”

Section: Introductionmentioning

confidence: 99%

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Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages

Bourgeois

Elseviers

Azermai

et al. 2011

Eur J Clin Pharmacol

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AIM:(i)To describe the prevalence of benzodiazepine use in Belgian nursing homes, with specific attention to indications and dosages.(ii)To compare actual and recommended dosages of benzodiazepines for anxiety and insomnia.(iii)To explore the risk profile for chronic benzodiazepine use in institutionalised older adults. METHODS:Medication charts of 1730 residents from 76 nursing homes in Belgium were collected and analysed, using the ATC classification. Drug name, indication and daily dosage were recorded. From authoritative international sources, we extracted for each drug and each indication a daily dosage recommended not to exceed in older adults, for comparison with observed actual dosages. RESULTS:Among the chronic BZD/Z users (50% of the residents), the leading indication was 'insomnia' (59% of the users) followed by 'anxiety' (17%) and 'unrest' (10%). In the chronic prescriptions of BZD/Zs indicated for insomnia, the actual daily dose exceeded the geriatric upper limit: with lormetazepam in 95% ,zolpidem in 82%, zopiclone in 78% and lorazepam in 35% of the prescriptions. In anxiety, daily doses also exceeded the limit but not to the same extend.Multivariate analysis showed BZD/Z use was positively associated with pain (OR 1.58 CI95% 1.27-1.97), constipation ) and depression (OR 1.68 CI95% 1.35-2.08). Residents with dementia were less likely of receiving a BZD/Z (OR 0.60 CI95% 0.48-0.74). CONCLUSION:Efforts to reduce the use of BZD/Zs in nursing homes should concentrate on insomnia, with interventions aimed to reduce too high prevalence of chronic use and too high daily dosages in this indication.3

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Section: Implications For Practice and Researchmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages

Bourgeois

Elseviers

Azermai

et al. 2011

Eur J Clin Pharmacol

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“…VPA has been shown to be unhelpful in agitation in AD (42) and is associated with cognitive decline (43). The long term use of BZDs has been associated with an increased risk for cognitive deterioration and falls (44,45).…”

Section: Seizure Treatment In Admentioning

confidence: 99%

Seizures in Alzheimer Disease: Clinical and Epidemiological Data

2012

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Epilepsy and AD are common neurologic disorders for which increasing age is a common and well-established risk factor (1, 2). The potential relation between these two disorders has been supported by experimental and clinical data. From a clinical aspect, patients with AD have an increased risk of developing seizures and epilepsy; thus AD may be an important cause of epilepsy in the elderly. AD and other neurodegenerative conditions represent the presumed etiology for 10% of new onset epilepsy in patients older than 65 (3).The diagnosis of seizures in patients with AD is not always easy because the manifestation of partial seizures might be hard to recognize and distinguish from other behaviors common in these patients. This may lead to underestimation of the real frequency of seizures in AD. At the same time, the possibility that "funny" or "unusual" behaviors of demented patients are considered seizures, particularly by nonepileptologists, may lead to overestimation of seizure rates.We briefly review and comment on studies reporting on the risk of seizures in AD, the possible factors modifying this risk, the role of EEG in the diagnosis of epilepsy and its limitations, the efficacy of antiepileptic drugs and the relationship between seizures and interictal epileptiform activity and AD course. Risk of Seizures in ADCompared with healthy individuals of the same age, patients with sporadic AD have a 6-to 10-fold increased risk of developing clinical seizures during the course of their illness (4-6). There are many prospective and retrospective studies reporting great variability in the lifetime prevalence of seizures in patients with AD, with rates ranging from 1.5 to 64 percent (5-17). However, it is difficult to accurately assess the real prevalence of seizures in AD because of methodological problems in published epidemiologic and observational studies. The studies in which there is pathologic confirmation of AD have small numbers of subjects, with considerable variability in disease duration and severity. Some prospective and retrospective studies have included other forms of dementia and patients with additional symptomatic causes of epilepsy, such stroke or hemorrhage. Two recent prospective cohort studies with large numbers of patients with long follow-up and carefully characterized evaluations estimate the overall incidence of seizures in AD at approximately 1 per 200 person-years of observation, suggesting relatively lower frequencies than other studies (17, 18).There are studies in the elderly reporting recurrence risk after the first seizure as high as 80%, probably because the epilepsy in the elderly population is mainly associated with an underlying structural lesion (15). In AD patients, many of the studies do not distinguish the presence of a single unprovoked seizure from recurrent seizures, namely, epilepsy. To our knowledge, there are no large studies reporting the risk of recurrence of seizures after the first unprovoked seizure in AD, except for few case series that include a small number of Se...

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“…Since at least 2002, a number of studies-nested casecontrol studies, [2][3][4] prospective studies, 5,6 a retrospective cohort study, 7 and a case control study 8 -have shown increases in the incidence of dementia with long-term use of benzodiazepines. The average overall increase is 51% with benzodiazepine use over 3 months, and the increase is higher with longer acting benzodiazepines.…”

mentioning

confidence: 99%

Hypnotics and the Risks of Dementia

James

2017

Journal of Clinical Sleep Medicine

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The Association Between Dementia and Long-Term Use of Benzodiazepine in the Elderly: Nested Case–Control Study Using Claims Data

Cited by 129 publications

References 31 publications

Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages

Benzodiazepine use in Belgian nursing homes: a closer look into indications and dosages

Seizures in Alzheimer Disease: Clinical and Epidemiological Data

Hypnotics and the Risks of Dementia

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