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Benzodiazepines and Dementia: What’s the Connection?
Written by Haleigh Behrman
about the author
9 minute readLast updated March 29, 2023
Anxiety and sleep disturbances are symptoms often associated with Alzheimer’s disease or other forms of dementia. Doctors may prescribe anti-anxiety medications or sleep aids to help seniors with dementia rest. However, sedative-hypnotic drugs, like Valium, Xanax, and other benzodiazepines, may be unsafe for older adults. Learn how benzodiazepines work, alternatives to benzodiazepines, and dementia-related risks associated with these medications.
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How do benzodiazepines work?
Benzodiazepines are a class of drugs that slow down messages sent from the brain to the body. They generally produce a calming, sedative effect when a person is overstimulated. Benzodiazepines affect the central nervous system, where they enhance the effect of gamma amino-butyric acid (GABA), the chemical that helps the body stay calm. There are a number of different benzodiazepines that vary in strength, what they treat, and how fast the body absorbs them. They are often prescribed to treat: Short-term use of these medications can be safe and effective, but there are potentially negative outcomes linked to long-term benzodiazepine use. These include: Long-term use can also lead to physical dependency or addiction, which can occur within only a few weeks of regular use. Helping your loved one keep track of their medications can prevent any drug misuse that may lead to dependency. Suddenly stopping benzodiazepine use can lead to severe withdrawal symptoms, so it is essential to contact your parent’s doctor before ending or changing a benzodiazepine treatment. Side effects such as breathing problems, overdose, or even death can result from combining benzodiazepines with the following: In some cases, anti-anxiety drugs may even react with herbal supplements and grapefruit juice, according to the Food and Drug Administration. Encourage your parent to always talk with their doctor or pharmacist before adding or discontinuing a drug while taking benzodiazepines. It’s also imperative to disclose all current medications and supplements to your doctor before beginning benzodiazepine treatment.
- Insomnia
- Anxiety
- Panic disorders
- Seizures
- Alcohol withdrawal symptoms
Side effects of benzodiazepines
Benzodiazepine side effects can vary in duration and severity from person to person. Some common benzodiazepine side effects include:- Drowsiness
- Memory problems
- Impaired coordination (especially in the elderly)
- Dizziness and light-headedness
- Confusion
- Increased anxiety
- Blurred vision
- Muscle weakness
- Development of lasting cognitive deficits or memory loss
- Coronary artery disease
- Schizophrenia
- Asthma or chronic obstructive pulmonary disease
- Depression
Using benzodiazepines with other drugs
Taking benzodiazepines with other medications may alter the effects of the drugs and lead to potentially dangerous interactions.- Alcohol
- Opioids
- Antidepressants
- Anticonvulsants
- Antipsychotics
- Antihistamines
Benzodiazepines and dementia risks
Benzodiazepines and related sedative-hypnotic drugs — medications used to calm or induce sleep — are known to interfere with memory function. There may even be a direct link between benzodiazepines and dementia risk, according to research published in Frontiers in Aging Neuroscience. These medications are notably associated with both short-term and lasting cognitive deficits. Though evidence is mixed, a study published by the British Medical Journal suggests there is an association between the use of benzodiazepines and dementia.
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To resolve the conflicting studies on the association of benzodiazepines and dementia, a 2019 meta-analysis of 10 studies claimed there is an increased risk in the elderly population from long-term use. It’s unclear if this association is causal. While some research implies that benzodiazepines increase dementia risks, other research points out that seniors may be prescribed these medications to treat anxiety, insomnia, or depression — all of which could be early symptoms of pre-existing, undiagnosed dementia, according to research from the journal Current Opinion in Psychiatry. These symptoms can include: Learning to spot early dementia symptoms in aging parents can provide helpful insight to doctors and result in a more accurate diagnosis.
- Irritability
- Anxiety
- Depression
- Apathy
- Agitation
- Sleep disturbances
Benzodiazepine use in the elderly
Benzodiazepine use is common and continuous among older adults, despite expert recommendations and the possible increased risk of dementia. The 2019 American Geriatrics Society Beers Criteria classifies a variety of benzodiazepines as potentially inappropriate for use among older adults due to the increased risk of: Older adults are especially vulnerable to these drugs’ negative side effects. As people age, their bodies metabolize medication differently, which can alter its effectiveness and cause adverse reactions. Prescribing benzodiazepines in low doses and for shorter durations can help minimize the side effects for older adults when treatment is necessary.
- Falls
- Delirium
- Fractures
- Accelerated cognitive decline
- Motor vehicle accidents
Sometimes, benzodiazepines are helpful
The 2019 AGS Beers Criteria also suggests benzodiazepine use may be appropriate for the elderly if it’s needed for certain conditions. These conditions include:- Seizure disorders
- Alcohol withdrawal
- Certain severe sleep disorders
Benzodiazepine alternatives
There are a number of pharmacological and non-pharmacological benzodiazepine alternatives that are safer for older adults and have lower risks of dependence and misuse. If you have concerns about your parent’s benzodiazepine treatment, consider reaching out to their doctor and seeing what alternatives may be a better fit for sleep problems or anxiety.
Non-benzodiazepine sleeping aids
There are several options available to help alleviate symptoms of insomnia in elderly adults. These include:- Cognitive behavioral therapy (CBT), which can help form better sleep habits by identifying the patterns that keep you awake
- Low doses of doxepin, which can help you stay asleep longer and wake up less throughout the night
- Melatonin supplements, which are available over the counter and may help you fall asleep faster
- Low-caffeinated green tea, which can help the body relax and improve sleep quality
- Ramelteon, an FDA-approved sleep aid that can help treat chronic insomnia
- Probiotics, which may have a positive effect on sleep quality
- Cannabidiol (CBD), which can help treat insomnia and improve sleep quality
Non-benzodiazepine anxiety treatments
There are also a number of alternative anti-anxiety medications that are less addictive than benzodiazepines, according to research published in the journal American Family Physician. These include:- Beta-blockers, which can be an effective treatment option for short-term anxiety
- Antidepressants, which are commonly used to help with anxiety and also target depression
- Low doses of antipsychotics, which can be helpful in addressing a variety of anxiety symptoms
- Buspirone, which is used for the short-term treatment of anxiety symptoms
- Monoamine oxidase inhibitors (MAOIs), which are usually prescribed to treat anxiety if antidepressants don’t work
- CBT, which can calm the nerves and change patterns that cause anxious feelings
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Why the connection between benzodiazepines and dementia matters
Worldwide, the number of people living with Alzheimer’s or other forms of dementia is projected to reach 139 million by 2050, according to the World Health Organization. With no preventive treatment or cure available, it’s important to learn more about benzodiazepine risks, especially if decreased use could potentially reduce the number of seniors who develop dementia. If you’re seeing signs that your loved one needs more care, or if you’re concerned about managing their medication needs at home, a Senior Care Advisor can discuss your family’s needs and recommend senior living or home care options near you.
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References
[1] Billioti de Gage, S., Moride, Y., Ducruet, T., Kurth, T., Verdoux, H., Tournier, M., Pariente, A., & Begaud, B. (2014, August). Benzodiazepine use and risk of Alzheimer’s disease: Case-control study. BMJ.
[2] Gallagher, H. (2013, September). Addressing the issue of chronic, inappropriate benzodiazepine use: How can pharmacists play a role?Pharmacy.
[3] Gerlach, L. B., Maust, D. T., Leong, S. H., Mavandadi, S., & Oslin, D. W. (2018, November). Factors associated with long-term benzodiazepine use among older adults. JAMA Internal Medicine.
[4] He, Q., Chen, X., Wu, T., Li, L., & Fei, X. (2019, January). Risk of dementia in long-term benzodiazepine users: Evidence from a meta-analysis of observational studies. Journal of Clinical Neurology.
[5] Longo, L., & Johnson, B. (2000, April). Addiction: Part I. benzodiazepines—side effects, abuse risk and alternatives. American Family Physician.
[6] Olfson, M., King, M., & Schoenbaum, M. (2015, February). Benzodiazepine use in the United States. JAMA Psychiatry.
[7] Simon, G. E., & Ludman, E. J. (2006, September). Outcome of new benzodiazepine prescriptions to older adults in primary care. General Hospital Psychiatry.
[8] Zhong, G., Wang, Y., Zhang, Y., & Zhao, Y. (2015, May). Association between benzodiazepine use and dementia: A meta-analysis. PLOS ONE.
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