Benzodiazepines consistently make the Top 5 list of most commonly prescribed medications in the United States. Benzodiazepines should generally be used for short-term control of symptoms (for example, anxiolysis) in the majority of cases. Prescribing patterns suggest that people stay on them long term, however. Community-based population studies demonstrate that among 5.5% of men and 9.8% of women 65 years of age and older using benzodiazepines at baseline, 50% of this group were still using them 15 years later.
All of us can easily think of patients in our panels who we have maintained on these medications for various indications. Discontinuing benzodiazepines can be difficult because of symptom rebound (such as worse symptoms) and re-emergence (that is, relapse) and should generally be tapered over several months. But beginning these discussions with patients are difficult for both us and them. But what are the risks on continuation?
Dr. Sophie Billioti de Gage of Université Bordeaux Segalen conducted a population-based study evaluating the association between use of benzodiazepines and incident dementia. In this study, 1,063 men and women with a mean age of 78 years free of dementia at baseline were followed for 15 years. During follow-up, new cases of dementia were diagnosed in 30 (32%) benzodiazepine users and 223 (23.0%) nonusers. New use of benzodiazepines was associated with an increased risk of dementia (multivariable adjusted hazard ratio, 1.60; 95% confidence interval, 1.08-2.38). Ever use of benzodiazepines was associated with an increased risk for dementia, compared with never use (adjusted odds ratio, 1.55; CI, 1.24-1.95). Estimates remained stable after adjustment for cognitive decline before starting benzodiazepines and clinically significant depression.
We do not know the potential impact of benzodiazepines among younger patients. But the findings from this study should provide us with some additional thought and motivation to address benzodiazepine use among our older patients. Given the commonly expressed dread of developing dementia among my older patients, this will help me at least get the conversation started.
Dr. Ebbert is professor of medicine and primary care clinician at the Mayo Clinic in Rochester, Minn. He reports having no conflicts of interest. The opinions expressed are solely those of the author.