Cognitive effects of benzodiazepine use: a review

Barker, Melinda; Jackson, Martin; Greenwood, Kenneth M.; Crowe, Simon F.

doi:10.1080/00050060310001707217

Cited by 15 publications

(11 citation statements)

References 96 publications

(144 reference statements)

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“…The slower psychomotor performance rates as plasma levels escalated (Table 3) also support this interpretation. Although similar effects have been observed in studies of single doses or a few repeated doses of alprazolam [Laurijssens and Greenblatt, 1996], our study seems to be the only one to examine psychomotor effects over a time span of several weeks [Barker et al, 2003]. Our results reinforce the importance of titrating alprazolam dosage upward gradually-more gradually than in this studyand cautioning patients about possible impairment of psychomotor function even after completing that process.…”

Section: Effects Of Increasing Alprazolam Plasma Levelssupporting

confidence: 86%

Cognitive style, alprazolam plasma levels, and treatment response in panic disorder

et al. 2008

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This study investigated an anxiety-prone cognitive style (measured by the Anxious Thoughts and Tendencies Questionnaire, AT&T) as a predictor of the acute response to increasing alprazolam plasma levels in panic disorder. Panic disorder patients (n 5 26) were treated with escalating doses of alprazolam for 4 weeks, then a fixed dose of 1 mg four times a day for 4 weeks. At 0, 1, 2, 3, 4, 6, and 8 weeks, trough alprazolam plasma levels; clinical, self-report, and performance measures; and vital signs were assessed. Panic attack data were from daily diaries. The repeated response measures were analyzed in relation to alprazolam plasma levels using SAS GENMOD, with patients classified as high or low on the baseline AT&T. Panic attacks, anticipatory anxiety, fear, avoidance, overall agoraphobia, the Hamilton Anxiety Rating Scale, and clinicians' global ratings improved with increasing alprazolam plasma levels. Hopkins Symptom Checklist-90 Anger-Hostility; Profile of Mood States Vigor, Confusion, and Friendliness; and speed and accuracy of performance worsened. Patients with high AT&T scores were worse throughout the study on situational panics, fear, avoidance, overall agoraphobia, the Hamilton Anxiety Rating Scale, the Hamilton Rating Scale for Depression, and Clinical Global Improvement; most Hopkins Symptom Checklist-90 clusters; Profile of Mood States Anxiety, Depression, and Confusion; and Continuous Performance Task omissions. We conclude that in panic disorder: (1) alprazolam has a broad spectrum of clinical activity related to plasma levels in individual patients; (2) sedation, disinhibition, and performance deficits may persist for at least a month after dose escalation ends; (3) marked anxiety-prone cognitions predict more symptoms throughout treatment, but do not modify the response to alprazolam and therefore should not influence the choice of alprazolam as treatment. Depression and Anxiety 25:E18-E26, 2008.

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Section: Effects Of Increasing Alprazolam Plasma Levelssupporting

confidence: 86%

Cognitive style, alprazolam plasma levels, and treatment response in panic disorder

et al. 2008

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“…However, previous research has suggested that long-term use of benzodiazepines is related to impairments in memory (Birzele, 1992;Curran, 1992;Curran et al, 1994;Massin-Krauss et al, 2002;Mintzer et al, 2001;Tata et al, 1994), attention and concentration (Birzele, 1992;Golombok, 1989;Golombok et al, 1988;Petursson et al, 1983), visuospatial skills (Bergman et al, 1980;Golombok et al, 1988;Sakol & Power, 1988;Tata et al, 1994), and numerous other cognitive functions (Aranko et al, 1983;Bergman et al, 1980Bergman et al, , 1989Birzele, 1992;Brosan et al, 1986;Gorenstein et al, 1994;Lucki et al, 1986;Petursson et al, 1983;Sakol & Power, 1988;Tata et al, 1994;Toenne et al, 1995). [See (Barker et al, 2003) for a recent review.] Some authors have also demonstrated a correlational relationship between benzodiazepine dose and observed deficits (Golombok et al, 1988;Tata et al, 1994).…”

Section: Introductionmentioning

confidence: 96%

An evaluation of persisting cognitive effects after withdrawal from long-term benzodiazepine use

Barker

Greenwood

Jackson

et al. 2005

J Int Neuropsychol Soc

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Twenty participants with self-reported long-term benzodiazepine use (mean 108 months) who had previously withdrawn from medication (mean 42 months) were administered a battery of neuropsychological tests. Each long-term user was case matched for age, sex, and education to two control participants who reported never taking benzodiazepines (those with and those without anxiety). The results indicated that long-term benzodiazepine use may lead to impairments in the areas of verbal memory, motor control/performance, and nonverbal memory but not visuospatial skills and attention/concentration. The length of abstinence (> 6 months) indicates that these impairments persist well beyond cessation of benzodiazepine use. However, observed impairments in the area of nonverbal memory were not solely attributable to benzodiazepine use and may be influenced by the elevated anxiety levels present in both the case and the anxious control group.

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“…Prior research, however, has also noted that some of these medication classes may negatively impact neuropsychological functioning. Benzodiazepines in particular have been shown to negatively impact visuospatial ability, speed of processing, and verbal learning (Barker, Jackson, Greenwood, & Crowe, 2003;Curran, 2000;Stewart, 2005). One metaanalysis noted moderate to large effect sizes for all cognitive domains, suggesting significant impairment with long-term benzodiazepine use (Barker, 2004a), with residual cognitive deficits observed for an additional six months (Barker, 2004b).…”

Section: Suggestions For Clinical Practice Andmentioning

confidence: 99%

Neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid analgesia

Block

Cianfrini²

2013

NRE

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BACKGROUND: The pervasive disease of chronic pain is a common challenge for the clinical rehabilitation professional. Concurrent with physical and emotional symptoms, pain-related cognitive impairment has been reported. Although opioid analgesics are frequently prescribed, concern exists that opioids possess adverse cognitive effects of their own. OBJECTIVES: To review the neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid therapy, to clarify roles and benefits of neuropsychological assessment in a chronic pain population, and to provide recommendations for clinical practice and future research. METHODS: This non-systematic review sought to provide a comprehensive synthesis of relevant neurobiology, neuroimaging, neuropsychological, and rehabilitation research literatures. We included citations from seminal and current texts as well as relevant original and review articles from 1980-2012 in PubMed and PubMedCentral online research databases. DISCUSSION AND SUMMARY/CONCLUSIONS: To date, evidence from opioid studies suggests only mild deficits in specific cognitive domains (e.g., memory, attention/concentration) and only under specific conditions (e.g., dose escalations). Additionally, neuroimaging and neuropsychological evidence suggests that pain itself results in cognitive sequelae. Methodological improvements in future research will allow for better delineation of the contributing effects of pain and opioids, with an overall goal of improving evidence-based clinical treatment recommendations.

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Cognitive effects of benzodiazepine use: a review

Cited by 15 publications

References 96 publications

Cognitive style, alprazolam plasma levels, and treatment response in panic disorder

Cognitive style, alprazolam plasma levels, and treatment response in panic disorder

An evaluation of persisting cognitive effects after withdrawal from long-term benzodiazepine use

Neuropsychological and neuroanatomical sequelae of chronic non-malignant pain and opioid analgesia

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