I swear I don’t go looking for alarming news about benzodiazepines, drugs widely prescribed for insomnia and anxiety. But it shows up with some frequency, so, mindful of your fervidly held views on the subject, I am donning a hazmat suit to bring you the latest findings from the medical journal BMJ.
In previous posts, I reported that long-term use by older people of drugs called sedative-hypnotics, which includes benzos (like Ativan, Xanax, Valium and Klonopin) and the related “z-drugs” (Ambien, Lunesta), has for years caused concern among some researchers.
Some readers took exception, arguing that critics minimize the miseries of chronic sleeplessness, reflexively condemn all drug dependence or condescendingly assume older people can’t make smart decisions. “The Ambien I use is low dose and I am not an idiot,” commented a miffed Margaret Moffitt of Roanoke, Va.
The doctors and health organizations I have spoken to, however, point to much higher rates of falls and fractures, auto accidents and cognitive problems in older patients taking sedative-hypnotics, along with increased emergency room visits and hospital admissions. Hence, the American Geriatrics Society’s inclusion of these drugs in its Choosing Wisely list of treatments that doctors and patients should question.
Now French and Canadian researchers are reporting — in a study designed with particular care — that benzodiazepine use is linked to higher rates of subsequent Alzheimer’s disease, and that the association strengthens with greater exposure to the drugs.
“The more the cumulative days of use, the higher the risk of later being diagnosed with dementia,” Dr. Antoine Pariente, a pharmacoepidemiologist at the University of Bordeaux and a co-author of the study, told me in an interview.
He and his colleagues reviewed medical records of almost 1,800 older people diagnosed with Alzheimer’s in the public health insurance program in Quebec, and compared them with nearly 7,200 control subjects. Most were over age 80.
About half those with Alzheimer’s and 40 percent of the control subjects had used benzodiazepines, the researchers found. That translated to a 51 percent increase in the odds of a subsequent Alzheimer’s diagnosis among the benzodiazepine users.
It was not short-term use that drove that finding: Older people who took prescribed doses for 90 days or fewer over the course of the study — patients were followed for six years or longer — had no increased risk.