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Pharmacopsychiatry 2014; 47(04/05): 145-150
DOI: 10.1055/s-0034-1381982
Original Paper
© Georg Thieme Verlag KG Stuttgart · New York

Changes in Cognitive Function during Psychogeriatric Treatment in Relation to Benzodiazepine Cessation

M. Tveito
1   Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
2   Institute of Clinical Medicine, University of Oslo, Norway
,
B. Lorentzen
1   Department of Geriatric Psychiatry, Diakonhjemmet Hospital, Oslo, Norway
,
K. Engedal
3   Norwegian Centre for Aging and Health, Vestfold Hospital Trust, Norway
,
L. Tanum
4   Norwegian Centre for Addiction Research, University of Oslo, Norway
,
J. G. Bramness
4   Norwegian Centre for Addiction Research, University of Oslo, Norway
5   Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
,
H. Refsum
5   Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
,
G. Høiseth
5   Center for Psychopharmacology, Diakonhjemmet Hospital, Oslo, Norway
6   Division of Forensic Medicine and Drug Abuse Research, Norwegian Institute of Public Health, Oslo, Norway
› Author Affiliations
Further Information

Publication History

received 28 January 2014
revised 04 May 2014

accepted 13 May 2014

Publication Date:
17 June 2014 (online)

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Abstract

Introduction: The aim of this study was to investigate cognitive functions after admission to a geriatric psychiatric hospital, and to study the short-term effects of cessation of benzodiazepine use on cognitive functions.

Methods: Details of benzodiazepine use and serum concentration measurements were recorded on admission. The Hopkins verbal learning test, the Stroop test, Digit Vigilance Test and the Mini Mental Status Examination were performed on admission, and after 4 weeks of hospitalization. Test results were compared for the total group of patients, as well as for benzodiazepine “continuers” and the “quitters”.

Results: For all patients (n=224), improved performances were observed in 10 out of 12 cognitive tests. Significant improvements were seen in 4 out of 12 tests. Benzodiazepine “quitters” improved significantly more than the “continuers” (p=0.027) only on the Hopkins verbal learning test, delayed recall performance.

Discussion: Among elderly psychiatric patients, cognitive function improved slightly during the 4 weeks of hospital treatment, but only for one of the memory tests, the improvement was related to the cessation of benzodiazepine treatment.

Key words

elderly - geriatric psychiatry - drug use - cognitive function - benzodiazepines
 

  • References

  • 1 Hoiseth G, Kristiansen KM, Kvande K et al. Benzodiazepines in geriatric psychiatry: what doctors report and what patients actually use. Drugs Aging 2013; 30: 113-118
    CrossrefPubMedGoogle Scholar
  • 2 Martinsson G, Fagerberg I, Wiklund-Gustin L et al. Specialist prescribing of psychotropic drugs to older persons in Sweden – a register-based study of 188,024 older persons. BMC Psychiatry 2012; 12: 197
    CrossrefPubMedGoogle Scholar
  • 3 Neutel CI, Skurtveit S, Berg C. What is the point of guidelines? Benzodiazepine and z-hypnotic use by an elderly population. Sleep Med 2012; 13: 893-897
    CrossrefPubMedGoogle Scholar
  • 4 Kleykamp BA, Griffiths RR, Mintzer MZ. Dose effects of triazolam and alcohol on cognitive performance in healthy volunteers. Exp Clin Psychopharmacol 2010; 18: 1-16
    CrossrefPubMedGoogle Scholar
  • 5 Roache JD, Griffiths RR. Comparison of triazolam and pentobarbital: performance impairment, subjective effects and abuse liability. J Pharmacol Exp Therap 1985; 234: 120-133
    PubMedGoogle Scholar
  • 6 Evans SM, Funderburk FR, Griffiths RR. Zolpidem and triazolam in humans: behavioral and subjective effects and abuse liability. J Pharmacol Exp Therap 1990; 255: 1246-1255
    PubMedGoogle Scholar
  • 7 Barker MJ, Greenwood KM, Jackson M et al. Cognitive effects of long-term benzodiazepine use: a meta-analysis. CNS Drugs 2004; 18: 37-48
    Google Scholar
  • 8 Puustinen J, Nurminen J, Kukola M et al. Associations between use of benzodiazepines or related drugs and health, physical abilities and cognitive function: a non-randomised clinical study in the elderly. Drugs Aging 2007; 24: 1045-1059
    CrossrefPubMedGoogle Scholar
  • 9 Puustinen J, Nurminen J, Lopponen M et al. Use of CNS medications and cognitive decline in the aged: a longitudinal population-based study. BMC Geriatrics 2011; 11: 70
    CrossrefPubMedGoogle Scholar
  • 10 van Vliet P, van der Mast RC, van den Broek M et al. Use of benzodiazepines, depressive symptoms and cognitive function in old age. Int J Geriat Psychiatry 2009; 24: 500-508
    CrossrefPubMedGoogle Scholar
  • 11 Billioti de Gage S, Begaud B, Bazin F et al. Benzodiazepine use and risk of dementia: prospective population based study. BMJ 2012; 345: e6231
    CrossrefPubMedGoogle Scholar
  • 12 Burton DG, Allen MC, Bird JL et al. Bridging the gap: ageing, pharmacokinetics and pharmacodynamics. J Pharm Pharmacol 2005; 57: 671-679
    CrossrefPubMedGoogle Scholar
  • 13 Turnheim K. Drug therapy in the elderly. Exp Gerontol 2004; 39: 1731-1738
    CrossrefPubMedGoogle Scholar
  • 14 Hoiseth G, Tanum L, Tveito M et al. A clinical study of the cognitive effects of benzodiazepines in psychogeriatric patients. Pharmacopsychiatry 2013; 46: 209-213
    Article in Thieme ConnectPubMedGoogle Scholar
  • 15 Barker MJ, Greenwood KM, Jackson M et al. An evaluation of persisting cognitive effects after withdrawal from long-term benzodiazepine use. J Int Neuropsycholog Soc: JINS 2005; 11: 281-289
    PubMedGoogle Scholar
  • 16 McAndrews PM, Weiss RT, Sandor P et al. Cognitive effects of long-term benzodiazepine use in older adults. Hum Psychopharmacol 2003; 18: 51-57
    CrossrefPubMedGoogle Scholar
  • 17 Tsunoda K, Uchida H, Suzuki T et al. Effects of discontinuing benzodiazepine-derivative hypnotics on postural sway and cognitive functions in the elderly. Int J Geriat Psychiatry 2010; 25: 1259-1265
    CrossrefPubMedGoogle Scholar
  • 18 Tata PR, Rollings J, Collins M et al. Lack of cognitive recovery following withdrawal from long-term benzodiazepine use. Psycholog Med 1994; 24: 203-213
    CrossrefPubMedGoogle Scholar
  • 19 Brandt J, Benedict RHB. Hopkins verbal learning test – revised: professional manual. Lutz, FL: Psychological Assessment Resources; 2001
    Google Scholar
  • 20 Stroop JR. Studies of interference in serial verbal reactions [Ph.D.]. Nashville, Tenn. George Peabody College for Teachers 1935; 19 p
    PubMedGoogle Scholar
  • 21 Lewis JL. Digit Vigilance Test: Professional users guide. Lutz FL: Psychological Assessment Resources; 1995
    Google Scholar
  • 22 Butters MA, Bhalla RK, Andreescu C et al. Changes in neuropsychological functioning following treatment for late-life generalised anxiety disorder. Br J Psychiatry 2011; 199: 211-218
    CrossrefPubMedGoogle Scholar
  • 23 Schneider N, Yvon C. A review of multidomain interventions to support healthy cognitive ageing. J Nutrition Health Aging 2013; 17: 252-257
    PubMedGoogle Scholar
  • 24 Beracochea D. Anterograde and retrograde effects of benzodiazepines on memory. Sci World J 2006; 6: 1460-1465
    CrossrefPubMedGoogle Scholar
  • 25 Curran HV, Collins R, Fletcher S et al. Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life. Psycholog Med 2003; 33: 1223-1237
    CrossrefPubMedGoogle Scholar
  • 26 Paterniti S, Dufouil C, Alperovitch A. Long-term benzodiazepine use and cognitive decline in the elderly: the Epidemiology of Vascular Aging Study. J Clin Psychopharmacol 2002; 22: 285-293
    CrossrefPubMedGoogle Scholar
  • 27 Hanlon JT, Horner RD, Schmader KE et al. Benzodiazepine use and cognitive function among community-dwelling elderly. Clin Pharmacol Therap 1998; 64: 684-692
    CrossrefPubMedGoogle Scholar
  • 28 Barbui C, Gastaldon C, Cipriani A. Benzodiazepines and risk of dementia: true association or reverse causation?. Epidemiol Psychiatric Sci 2013; DOI: 10.1017/S2045796013000358. 1-2
    PubMedGoogle Scholar
  • 29 Mura T, Proust-Lima C, Akbaraly T et al. Chronic use of benzodiazepines and latent cognitive decline in the elderly: results from the Three-city study. Eur Neuropsychopharmacol 2013; 23: 212-223
    CrossrefPubMedGoogle Scholar
  • 30 Lenth RV. Java Applets for Power and Sample Size (Computer software). http://www.stat.uiowa.edu/-rlenth/Power2006-9
    PubMedGoogle Scholar
  • 31 Streiner DL, Norman GR. Correction for multiple testing: is there a resolution?. Chest 2011; 140: 16-18
    CrossrefPubMedGoogle Scholar
  • 32 Nurminen J, Puustinen J, Piirtola M et al. Psychotropic drugs and the risk of fractures in old age: a prospective population-based study. BMC Pub Health 2010; 10: 396
    CrossrefPubMedGoogle Scholar
  • 33 Sylvestre MP, Abrahamowicz M, Capek R et al. Assessing the cumulative effects of exposure to selected benzodiazepines on the risk of fall-related injuries in the elderly. Int Psychogeriat/IPA 2012; 24: 577-586
    PubMedGoogle Scholar
  • 34 Finkle WD, Der JS, Greenland S et al. Risk of fractures requiring hospitalization after an initial prescription for zolpidem, alprazolam, lorazepam, or diazepam in older adults. J Am Geriat Soc 2011; 59: 1883-1890
    CrossrefPubMedGoogle Scholar
  • 35 Glass J, Lanctot KL, Herrmann N et al. Sedative hypnotics in older people with insomnia: meta-analysis of risks and benefits. BMJ 2005; 331: 1169
    Google Scholar