Effects of discontinuing benzodiazepine-derivative hypnotics on postural sway and cognitive functions in the elderly

• Published in: International journal of geriatric psychiatry Vol. 25; no. 12; pp. 1259 - 1265
• Main Authors: Tsunoda, Kenichi, Uchida, Hiroyuki, Suzuki, Takefumi, Watanabe, Koichiro, Yamashima, Tetsumori, Kashima, Haruo
• Format: Journal Article
• Language: English
• Published: Chichester, UK John Wiley & Sons, Ltd 01.12.2010; Psychology Press; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; Attention; Benzodiazepine; Biological and medical sciences; Bipolar disorder; Clinical trials; Cognition - drug effects; Cognitive ability; cognitive function; Cognitive therapy; Daytime; Dementia disorders; Drug dosages; elderly; Female; Flicker fusion; Flicker Fusion - drug effects; flurazepam; Flurazepam - therapeutic use; Fundamental and applied biological sciences. Psychology; General aspects; Geriatric Assessment; Geriatric psychiatry; Geriatrics; Humans; hypnotic; Hypnotics; Hypnotics and Sedatives - therapeutic use; Inventories; Language; Male; Medical sciences; Memory; Mental disorders; Neuropsychological Tests; Nursing; Nursing homes; Older people; Postural Balance - drug effects; postural sway; Posture; Psychoanalysis; Psychology. Psychoanalysis. Psychiatry; Psychopathology. Psychiatry; Psychotropic drugs; Schizophrenia; side effect; Side effects; Sleep - drug effects; Sleep disorders; Surveys and Questionnaires; Human; cognitive function; side effect; Nervous system diseases; Psychotropic; Toxicity; Psychology; Hypnotic; Cognition; Equilibrium disorder; Gerontology; Secondary effect; ENT disease; Benzodiazepine derivatives; Elderly; Psychiatry; benzodiazepine; postural sway; Geriatrics
• ISSN: 0885-6230; 1099-1166; 1099-1166
• DOI: 10.1002/gps.2465

Objective Benzodiazepines (BZDs) have been reported to cause negative impacts on body stability and cognitive functions, which in turn could result in lethal incidents, including falls, especially in the elderly. This fact notwithstanding, no systematic trial has evaluated the feasibility and benefits of discontinuing BZD‐derivative hypnotics in this population, which was addressed in this study. Methods In this 8‐week open‐label study, subjects aged ≥60 living in a nursing home who received BZD as a hypnotic were recruited. The BZD dose was tapered off over 3 weeks. The following assessments were performed 12 h post‐dose at baseline and at endpoint: the Clinical Stabilometric Platform (CSP), the Critical Flicker Fusion Test (CFF), the Repeatable Battery for the Assessment of Neuropsychological Status (RBANS), and the Leeds Sleep Evaluation Questionnaire (LSEQ). Results Thirty subjects were enrolled (mean ± SD age = 79.1 ± 8.9 years, mean ± SD flurazepam equivalent BZD dose = 19.5 ± 10.9 mg/day). Psychiatric diagnoses (DSM‐IV) of subjects were as follows: schizophrenia (n = 12), primary insomnia (n = 9), dementia (n = 7), and bipolar disorder (n = 2). In 26 completers, significant changes were found in a total length and a range of trunk motion with eyes closed. Significant improvements were also observed in the CFF and RBANS immediate memory, language, and attention index scores. Subjective worsening in sleep was not reported in those completers, assessed with the LSEQ. Conclusions Our results suggest that discontinuation of BZD hypnotics is feasible in a majority of elderly persons and leads to an improvement in the stability of body and a recovery in cognitive functions during the daytime. Copyright © 2010 John Wiley & Sons, Ltd.