Benzodiazepine exposure in subjects with incident Alzheimer’s disease and related syndromes in France: a longitudinal study 2011–2017

Abstract

Benzodiazepines are commonly used for behavioral and psychiatric symptoms of dementia, despite their numerous adverse effects and the lack of evidence regarding their efficacy in this context. We studied longitudinal benzodiazepines exposure in incident cases of Alzheimer’s disease and related syndromes (ADRS) in France. We used a cohort of incident ADRS patients identified in 2012 within the national health data system. Benzodiazepines exposure was measured 1 year before, to 5 years after ADRS identification. Quarterly benzodiazepines prevalence and incidence were computed. We identified factors associated with long half-life benzodiazepines initiation. A total of 106 508 subjects were included. Quarterly benzodiazepines prevalence was stable (around 25%) but we saw an important decrease in long half-life benzodiazepines compensated by an increase in short half-life benzodiazepines. In most benzodiazepine initiations, the first episode lasted less than 3 months. Factors associated with initiating a long half-life benzodiazepine were young age, male gender, no registration with ADRS as a long-term disease, having consulted an ADRS specialist, antipsychotic reimbursement before the index date, no admission in nursing home. Prevalence of benzodiazepines use remains high in subjects with ADRS despite guidelines for their avoidance. However, indicators regarding benzodiazepine initiations (duration, benzodiazepine type) suggest some caution in their use.

Strategies for improving schizophrenia treatment

“…The second paper in this issue suggests that short-term benzodiazepine use is associated with a range of less severe clinical manifestations when compared with long-term or no benzodiazepine use (Ekinci and Ekinci, 2022). Despite the fact that the cross-sectional design of the study does not allow to determine causality, this result is convergent with clinical practice and previous evidence (Dold et al , 2013), obtained also in other disorders (Lim et al , 2020; Poncet et al , 2020). Nevertheless, long-term benzodiazepine use remains very common in clinical practice, particularly in the elderly (Bénard-Laribière et al , 2017).…”

Does a steroid dementia syndrome really exist? A brief narrative review of what the literature highlights about the relationship between glucocorticoids and cognition

“…Drugs may impair cognition indirectly via metabolic effects, such as hypoglycaemia, by alterations of immunological factors within the central nervous system, by actions that interfere with synaptic transmission, or by direct neurotoxicity (modified tau protein phosphorylation has been proposed as a factor capable of modifying the neuronal cytoskeleton). [25][26][27][28] The lack of a validated scale or algorithm is a relevant methodological limit in approaching the relationship between GCs and dementia. Nonetheless, this relationship is not linear because a close temporal association is not always present and a reversible dementia is not the rule, contrary to psychiatric adverse events.…”