Hostname: page-component-78c5997874-m6dg7 Total loading time: 0 Render date: 2024-11-10T19:54:52.971Z Has data issue: false hasContentIssue false
  • English
  • Français

Sedative use and incident cognitive decline among persons aged 75 years and older: a population-based longitudinal study

Published online by Cambridge University Press:  16 August 2011

Franciska Desplenter ,
Piia Lavikainen ,
Sirpa Hartikainen ,
Raimo Sulkava  and
J. Simon Bell
Franciska Desplenter
Affiliation:
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland Research Centre for Pharmaceutical Care and Pharmaco-economics, Faculty of Pharmaceutical Sciences, Katholieke Universiteit Leuven, Leuven, Belgium
Piia Lavikainen
Affiliation:
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland
Sirpa Hartikainen
Affiliation:
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland Leppävirta Health Centre, Leppävirta, Finland
Raimo Sulkava
Affiliation:
Institute of Public Health and Clinical Nutrition, Department of Geriatrics, University of Eastern Finland, Kuopio, Finland Department of Neurology, Kuopio University Hospital, Kuopio, Finland
J. Simon Bell*
Affiliation:
Kuopio Research Centre of Geriatric Care, University of Eastern Finland, Kuopio, Finland Clinical Pharmacology and Geriatric Pharmacotherapy Unit, School of Pharmacy, Faculty of Health Sciences, University of Eastern Finland, Kuopio, Finland Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Adelaide, Australia
*
Correspondence should be addressed to: J. Simon Bell, PhD, Associate Professor, Quality Use of Medicines and Pharmacy Research Centre, Sansom Institute, School of Pharmacy and Medical Sciences, University of South Australia, Frome Road, Adelaide, 5000, Australia. Phone: +61 8 8302 2419. Email: simon.bell@unisa.edu.au.
Get access Rights & Permissions [Opens in a new window]

Abstract

Background: Acute exposure to sedative drugs may induce memory impairment, but there is mixed evidence that long-term sedative use may result in incident cognitive decline. The objective of this study was to investigate the use of sedative drugs and incident cognitive decline in a population-based sample of persons aged 75 years and older.

Methods: The study sample comprised 781 participants in the Geriatric Multidisciplinary Strategy for the Good Care of the Elderly (GeMS) study in Kuopio, Finland. Data on health status, drug use, and sociodemographic factors were elicited during annual nurse interviews from 2004 to 2007. A linear mixed model was used to compare change in Mini-Mental State Examination (MMSE) scores (2005–2007) among users of sedative drugs in 2004 and 2005 (n = 139) to non-users of sedative drugs from 2004 to 2007 (n = 310). The model was adjusted for covariates including age, gender, education, depressive symptoms and antipsychotic use.

Results: Unadjusted mean MMSE scores were 27.50 in 2005, 26.58 in 2006, and 25.95 in 2007 among users of sedative drugs. Unadjusted mean MMSE scores were 28.05 in 2005, 27.61 in 2006, and 27.09 in 2007 among non-users of sedative drugs. Adjusted mean MMSE scores were 0.31 points lower in 2005, 0.62 points lower in 2006, and 0.93 lower in 2007 among users compared to non-users of sedative drugs (P = 0.051).

Conclusions: Sedatives were not associated with statistically significant cognitive decline. However, clinicians should maintain a judicious approach to prescribing sedative drugs given the risk of adverse drug events.

Keywords

psychotropic drugsFinlandagedcohort studiespharmacoepidemiology
Type
Research Article
Information
International Psychogeriatrics , Volume 24 , Issue 1 , January 2012 , pp. 48 - 54
Copyright
Copyright © International Psychogeriatric Association 2011

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Allard, J., Artero, S. and Ritchie, K. (2003). Consumption of psychotropic medication in the elderly: a re-evaluation of its effect on cognitive performance. International Journal of Geriatric Psychiatry, 18, 874–878.CrossRefGoogle ScholarPubMed
Assem-Hilger, E., Jungwirth, S., Weissgram, S., Kirchmeyr, W., Fischer, P. and Barnas, C. (2009). Benzodiazepine use in the elderly: an indicator for inappropriately treated geriatric depression? International Journal of Geriatric Psychiatry, 24, 563–569.CrossRefGoogle ScholarPubMed
Azad, N. A., Al Bugami, M. and Loy-English, I. (2007). Gender differences in dementia risk factors. Gender Medicine, 4, 120–129.CrossRefGoogle ScholarPubMed
Barker, M. J., Greenwood, K. M., Jackson, M. and Crowe, S. F. (2004). Persistence of cognitive effects after withdrawal from long-term benzodiazepine use: a meta-analysis. Archives of Clinical Neuropsychology, 19, 437–454.CrossRefGoogle ScholarPubMed
Belleville, G. (2010). Mortality hazard associated with anxiolytic and hypnotic drug use in the national population health survey. Canadian Journal of Psychiatry, 55, 558–567.CrossRefGoogle ScholarPubMed
Byerly, M. J., Weber, M. T., Brooks, D. L., Snow, L. R., Worley, M. A. and Lescouflair, E. (2001). Antipsychotic medications and the elderly: effects on cognition and implications for use. Drugs and Aging, 18, 45–61.CrossRefGoogle ScholarPubMed
Dealberto, M. J., McAvay, G. J., Seeman, T. and Berkman, L. (1997). Psychotropic drug use and cognitive decline among older men and women. International Journal of Geriatric Psychiatry, 12, 567–574.3.0.CO;2-V>CrossRefGoogle ScholarPubMed
Dewey, M. E. and Saz, P. (2001). Dementia, cognitive impairment and mortality in persons aged 65 and over living in the community: a systematic review of the literature. International Journal of Geriatric Psychiatry, 16, 751–761.CrossRefGoogle ScholarPubMed
Fastbom, J., Forsell, Y. and Winblad, B. (1998). Benzodiazepines may have protective effects against Alzheimer disease. Alzheimer Disease and Associated Disorders, 12, 14–17.CrossRefGoogle ScholarPubMed
Fortin, D. et al. (2007). Factors associated with long-term benzodiazepine use among elderly women and men in Quebec. Journal of Women and Aging, 19, 37–52.CrossRefGoogle ScholarPubMed
Hanlon, J. T. et al. (1998). Benzodiazepine use and cognitive function among community-dwelling elderly. Clinical Pharmacology and Therapeutics, 64, 684–692.CrossRefGoogle ScholarPubMed
Kidd, P. M. (2008). Alzheimer's disease, amnestic mild cognitive impairment, and age-associated memory impairment: current understanding and progress toward integrative prevention. Alternative Medicine Review, 13, 85–115.Google ScholarPubMed
Lagnaoui, R. et al. (2002). Benzodiazepine use and risk of dementia: a nested case-control study. Journal of Clinical Epidemiology, 55, 314–318.CrossRefGoogle ScholarPubMed
Lagnaoui, R. et al. (2004). Patterns and correlates of benzodiazepine use in the French general population. European Journal of Clinical Pharmacology, 60, 523–529.CrossRefGoogle ScholarPubMed
Lagnaoui, R. et al. (2009). The risk of cognitive impairment in older community-dwelling women after benzodiazepine use. Age and Ageing, 39, 226–228.Google Scholar
Madhusoodanan, S. and Bogunovic, O. J. (2004). Safety of benzodiazepines in the geriatric population. Expert Opinion on Drug Safety, 3, 485–493.CrossRefGoogle ScholarPubMed
McLachlan, A. J., Hilmer, S. N. and Le Couteur, D. (2009). Variability in response to medicines in older people: phenotypic and genotypic factors. Clinical Pharmacology and Therapeutics, 85, 431–433.CrossRefGoogle ScholarPubMed
McShane, R., Keene, J., Gedling, K., Fairburn, C., Jacoby, R. and Hope, T. (1997). Do neuroleptic drugs hasten cognitive decline in dementia? Prospective study with necropsy follow up. BMJ, 314, 266–270.CrossRefGoogle ScholarPubMed
Moride, Y. and Abenhaim, L. (1994). Evidence of the depletion of susceptibles effect in non-experimental pharmacoepidemiologic research. Journal of Clinical Epidemiology, 47, 731–737.Google ScholarPubMed
Mossello, E. et al. (2008). Is antidepressant treatment associated with reduced cognitive decline in Alzheimer's disease? Dementia and Geriatric Cognitive Disorders, 25, 372–379.CrossRefGoogle ScholarPubMed
Paterniti, S., Dufouil, C. and Alperovitch, A. (2002). Long-term benzodiazepine use and cognitive decline in the elderly: the Epidemiology of Vascular Aging Study. Journal of Clinical Psychopharmacology, 22, 285–293.CrossRefGoogle ScholarPubMed
Paterniti, S., Verdier-Taillefer, M. H., Dufouil, C. and Alpérovitch, A. (2002). Depressive symptoms and cognitive decline in elderly people: a longitudinal study. British Journal of Psychiatry, 181, 406–410.CrossRefGoogle Scholar
Rikala, M., Korhonen, M. J., Sulkava, R. and Hartikainen, S. (2011). The effects of medication assessment on psychotropic drug use in the community-dwelling elderly. International Psychogeriatrics, 23, 473–484.CrossRefGoogle ScholarPubMed
Stern, Y. (2006). Cognitive reserve and Alzheimer disease. Alzheimer Disease and Associated Disorders, 20 (Suppl. 2), S69–S74.CrossRefGoogle ScholarPubMed
Stewart, S. A. (2005). The effects of benzodiazepines on cognition. Journal of Clinical Psychiatry, 66 (Suppl. 2), 9–13.Google ScholarPubMed
Tangalos, E. G. et al. (1996). The Mini-Mental State Examination in general medical practice: clinical utility and acceptance. Mayo Clinic Proceedings, 71, 829–837.CrossRefGoogle ScholarPubMed
van Vliet, P., van der Mast, R. C., van den Broek, M., Westendorp, R. G. and de Craen, A. J. (2009). Use of benzodiazepines, depressive symptoms and cognitive function in old age. International Journal of Geriatric Psychiatry, 24, 500–508.CrossRefGoogle ScholarPubMed
Verbeke, G. and Molenberghs, G. (2000). Linear Mixed Models for Longitudinal Data. New York: Springer.Google Scholar
Wright, R. M. et al. (2009). Effect of central nervous system medication use on decline in cognition in community-dwelling older adults: findings from the Health, Aging And Body Composition Study. Journal of the American Geriatrics Society, 57, 243–250.CrossRefGoogle ScholarPubMed