Click photo to enlarge
Dr. Bill Elliott, photographed in 2004 (IJ photo/Robert Tong)
Related
CAN TAKING tranquilizers like Valium and Ativan lead to dementia in the elderly? That is the finding of a new study from France, published two weeks ago in the prestigious British Medical Journal. The study suggests that older adults who start taking tranquilizers are at a 50 percent increased risk of developing dementia compared to those who don't take the drugs.
The study looked at the use of common tranquilizer medications called benzodiezepines and their effect on about 1,100 older adults in France over a 15-year time frame. The average age of patients enrolled in the study was 78 and none of them had dementia or took tranquilizers at the beginning of the study. Benzodiazepines are commonly used in France — more than in this country — to treat anxiety and to help with sleep. Along with Valium (diazepam) and Ativan (lorazepam), drugs in this class include Xanax (alprazolam), Librium (chlordiazepoxide), Klonopin (clonazepam) and Restoril (temazepam), among others.
All these drugs are very similar in structure and function and all cause a degree of relaxation and sedation, but they also have side effects including confusion and memory loss.
Previous studies have indirectly linked these drugs to the development of dementia, but this study was the first designed to look at this issue alone.
The researchers began the study in 1987. None of the patients were on benzodiezepines and none had
dementia when they were enrolled in the study. As they followed the test subjects, about 10 percent of the patients were prescribed one of these drugs by their doctors for a range of conditions. After 15 years of follow-up, the rate of dementia was 50 percent higher in those patients taking benzodiezepines than those not taking the drugs.

The obvious critique of the study was the issue of "selection bias." Perhaps the patients who were prescribed the drugs were in the early stages of dementia already and that's why they needed tranquilizers. But the authors did their best to control for that. They looked at age, gender, educational level, marital status, alcohol consumption, diabetes, high blood pressure, depression and signs of early dementia. After controlling for all those factors, they still found that the drugs were associated with a risk of developing dementia. This suggests that the drugs may play a role in brain injury or other factors that lead to dementia.
In this country, there has been a push to avoid benzodiezepines in the elderly. The drugs not only affect memory, they are also linked to balance problems, falls and fractures. The drugs are labeled as "high risk medications" by Medicare and have not been covered under the Medicare drug benefit (although under pressure from several fronts, including the drug manufacturers, that will change next year).
In the meantime, it's a good idea to avoid these type of medications if you are older than 75 and really don't need them. This study and others add to "accumulating evidence that the use of benzodiezepines is associated with increased risk of dementia" and that constitutes "a substantial public health concern" according to the authors of the study.
If the drugs are needed, they should only be used for the shortest duration possible — certainly no more than a few weeks. Daily, uncontrolled use should be "cautioned against."
The authors also urge research to see if using the drugs at a younger age may contribute to dementia as well.
As with any medication, a risk/benefit analysis needs to be done before use. For the elderly, the data from this study suggests that the risk of benzodiazepine tranquilizers may be more significant than we previously thought.
Dr. Bill Elliott is an internist at Kaiser Novato and an assistant clinical professor of medicine at UCSF. His column appears every third Monday.