Association between high cumulative dose of benzodiazepine in Chinese patients and risk of dementia: a preliminary retrospective case–control study

Chan, Tsz-tai; Leung, William Chun-yin; Li, Victor C.; Wong, K. W.; Chu, Wing-Ming; Leung, Kwok‐Yin; Ng, Yuen Keng; Kai, Yuen-ming Gary; Shea, Yat‐Fung; Chang, Shek-kwan Richard; Chu, Leung‐Wing

doi:10.1111/psyg.12239

Cited by 24 publications

(30 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Cheng HT et al [17] and Lee J et al [19] reported that use of Zolpidem was associated with an increased risk of Alzheimer's disease among older people, especially a high cumulative dose, while Shih HI et al [18] found that the effect of Zolpidem on cognition in patients with AD remained uncertain. Our ndings of BZDs use were consistent with several previous studies that reported long term use of BZDs increases risk of cognitive incline [10][11][12], though there were also some studies that reported no association between BZDs use and cognitive impairment [9,[13][14][15][16]. For retrospective studies, lacking well-controlling confounders, such as education level, marriage, depression, stroke, diabetes, hypertension, coronary heart disease, physical activity, smoking, medicines affected cognition, especially insomnia, is the possible cause of these inconsistent ndings.…”

Section: Discussionsupporting

confidence: 92%

“…The effect of BZDs on cognition in the elderly is highly debated. Some studies have reported that long term use increase the risk of cognitive impairment [10][11][12], others have shown the contrary results [9,[13][14][15][16]. Although the association between BZDs and cognitive decline remains uncertain, it was determined that the use of BZDs in elderly should be avoided or limited for the short term.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Association Between Z Drugs Use and Risk of Cognitive Impairment in Older Patients With Chronic Insomnia

Guo

Zhang

et al. 2020

Preprint

View full text Add to dashboard Cite

Background Benzodiazepines (BZDs) and Z drugs are widely used for patients with chronic insomnia. The long term use of BZDs in older patients can cause cognitive impairment and potentially increase the risk of dementia. However, evidence for an association with Z drugs is limited. This study aimed to investigate the association between the risk of cognitive impairment and exposure to Z drugs in older patients with chronic insomnia.Methods We recorded older patients with chronic insomnia who visited the outpatient department of neurology, Beijing Friendship Hospital, and assessed the global cognitive function (MoCA) and five cognitive domains (CVLT, TMT-B, BNT-30, CDT and DST). Multiple regression analysis was conducted to determine the independent factors of cognition, and evaluate the effect of Z drugs use (zolpidem and zopiclone) on cognition.Results A total of 88 subjects were identified. BZDs use (P=0.03, B=2.67, 95% CI 0.36-4.97) and BZDs exposure density (P=0.01, B=1.22, 95% CI 0.33-2.11) were independent risk factors of cognitive impairment in older patients with chronic insomnia. Neither Z drugs use (P=0.11) nor Z drugs exposure density (P=0.92) correlated with global cognitive function. Moreover, compared with BZDs users, there were positive associations between Z drugs use and memory (P=0.00), attention (P=0.00) and verbal function (P=0.04). Additionlly, education level (P=0.02, OR=0.74, 95% CI 0.57-0.95), duration of insomnia (P=0.04, OR=1.05, 95% CI 1.00-1.11) and severity of insomnia (P=0.03, OR=1.27, 95% CI 1.02-1.57) were also independent factors of global cognitive function.Conclusion We found no evidence that Z drugs use and Z drugs exposure density were associated with cognitive impairment in older patients with chronic insomnia. However, the use of BZDs and BZDs exposure density were associated with an increased risk of cognitive impairment. Thus, BZDs use should be avoided，and Z drugs should be prescribed with extreme caution in the elderly.

show abstract

Section: Discussionsupporting

confidence: 92%

Section: Introductionmentioning

confidence: 99%

Association Between Z Drugs Use and Risk of Cognitive Impairment in Older Patients With Chronic Insomnia

Guo

Zhang

et al. 2020

Preprint

View full text Add to dashboard Cite

show abstract

“…All other studies focused on the association between BZD and dementia risk. Eight case control studies (Billioti de Gage et al, ; Chan et al, ; Gomm et al, ; Imfeld, Bodmer, Jick, & Meier, ; Takada, Fujimoto, & Hosomi, ; Tapiainen et al, ; C.‐S. Wu, Ting, Wang, Chang, & Lin, ; C.‐S.…”

Section: Resultsmentioning

confidence: 99%

“…All other studies focused on the association between BZD and dementia risk. Eight case control studies (Billioti de Gage et al, 2014;Chan et al, 2017;Imfeld, Bodmer, Jick, & Meier, 2015;Takada, Fujimoto, & Hosomi, 2016;Tapiainen et al, 2018;C.-S. Wu, Ting, Wang, Chang, & Lin, 2011;C.-S. Wu, Wang, Chang, & Lin, 2009) and four cohort studies (Billioti de Gage et al, 2012;Gallacher et al, 2012;Gray et al, 2016;Shash et al, 2016) showed a significant association between chronic BZD use and increased risk of dementia.…”

Section: Benzodiazepinesmentioning

confidence: 99%

Drug interactions with dementia‐related pathophysiological pathways worsen or prevent dementia

Barus

Béné

Deguil

et al. 2019

British J Pharmacology

View full text Add to dashboard Cite

Many risk factors are known to induce or precipitate dementia. Drugs acting via different mechanisms can modulate cognitive performance and exert either beneficial or deleterious effects on cognition through functional or neuropathological mechanisms. This review discusses the association between several classes of drugs and cognitive impairment and dementia risk. These drugs can be divided into drugs targeting CNS disorders (e.g., anticholinergic drugs, antiepileptics, antipsychotics, benzodiazepines, and opioids) and drugs targeting non‐CNS disorders (e.g., antidiabetics, antihypertensives, proton pump inhibitors, and statins). Furthermore, we sought to highlight the pharmacological mechanisms underlying their possible detrimental or beneficial effects on cognition. Anticholinergic and antiepileptic drugs were excluded from this review because their effects on cognition are well known. Studies investigating benzodiazepines have revealed an increased risk of dementia. Conclusions on dementia risk or cognitive impairment regarding opioids and antipsychotic drugs are difficult to draw. These different classes appear to impair cognition not by a single clear mechanism of action specific to each class but by several relatively interdependent and interconnected mechanisms (e.g., impaired neurotransmission, neuroinflammation, neuronal death, oxidative stress, or interactions with dementia‐related pathways). The dementia risk initially associated with the use of proton pump inhibitors might have been overestimated. In contrast, statins, antihypertensive medications, and antidiabetics could potentially decrease the risk of dementia and cognitive impairment by acting in ways opposite to the mechanisms cited above. Linked Articles This article is part of a themed section on Therapeutics for Dementia and Alzheimer's Disease: New Directions for Precision Medicine. To view the other articles in this section visit http://onlinelibrary.wiley.com/doi/10.1111/bph.v176.18/issuetoc

show abstract

“…Uma associação positiva pode ser explicada pelo fato de que a exposição foi motivada pelos primeiros sintomas da doença (VERDOUX et al, 2005;COELHO et al, 2006;BILLIOTI DE GAGE et al, 2015). Um recente estudo caso-controle com 91 indivíduos caso e 182 indivíduos controles com idade igual ou superior a 75 anos, observou que indivíduos chineses podem desenvolver demência quando administram altas doses de benzodiazepínicos (CHAN et al, 2017).…”

Section: Introductionunclassified

O Uso Prolongado De Benzodiazepínicos Por Idosos E O Risco Para Demência

Faria

Budni

2018

Inova

View full text Add to dashboard Cite

A população está envelhecendo e com isso, políticas de saúde precisam ser desenvolvidas, para fornecer maior qualidade de vida à população idosa. Há um grande número de indivíduos idosos que administram vários medicamentos em função das comorbidades do envelhecimento. Entre estes fármacos estão os benzodiazepínicos. Estes causam vários efeitos colaterais, entre eles a amnésia, uma queixa constante dos idosos. Portanto, estudo tem por objetivo relacionar o uso prolongado de benzodiazepínicos em idosos e o risco para o desenvolvimento da demência. Alguns estudos mostram que vários sintomas que antecedem a demência são tratados com benzodiazepínicos. São vários os fatores de risco atribuídos ao uso desses fármacos em idosos, como déficit cognitivo, quedas, fraturas, etc. A indicação do uso e seu tempo de uso, devem ser constantemente avaliados, pois seu uso prolongado causará muitos prejuízos a curto prazo. Estudos apontam um risco aumento para os indivíduos idosos em desenvolver demências com o uso prolongado de benzodiazepínicos. A população mundial está envelhecendo, e portanto, precisa-se do desenvolvimento de políticas públicas de saúde para as pessoas com mais de 60 anos para que estas sejam assistidas e que, inclusive, se possa ter maiores informações acerca do efeito prolongado de certos medicamentos, como os benzodiazepínicos. Adicionais pesquisas relacionadas aos fármacos que possam ser utilizados por idosos e que não comprometam a saúde dos mesmos, e sim aumentam a qualidade de vida destes, são necessários.

show abstract

Association between high cumulative dose of benzodiazepine in Chinese patients and risk of dementia: a preliminary retrospective case–control study

Abstract: High-dose benzodiazepine use may be associated with dementia in the Chinese population. Prospective studies are required.

Cited by 24 publications

References 30 publications

Association Between Z Drugs Use and Risk of Cognitive Impairment in Older Patients With Chronic Insomnia

Association Between Z Drugs Use and Risk of Cognitive Impairment in Older Patients With Chronic Insomnia

Drug interactions with dementia‐related pathophysiological pathways worsen or prevent dementia

O Uso Prolongado De Benzodiazepínicos Por Idosos E O Risco Para Demência

Contact Info

Product

Resources

About