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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 17 of 17. This is the beginning of the thread.
Posted by Phillipa on February 4, 2016, at 10:26:03
New study delivered to my RN newsletter now states that long term use of benzos there is no risk of dementia or Alzheimers. The other studies were wrong . I can only copy & past page one. as is two pages but will do that. Have been worried for years since been on low doses since the 70's Phillipa. Will copy & paste page one the rest is from Medscape.
Posted by Phillipa on February 4, 2016, at 10:28:37
In reply to Benzodiazepines: No Dementia Risk?, posted by Phillipa on February 4, 2016, at 10:26:03
edscape Medical News > Psychiatry
Benzodiazepines: No Dementia Risk?
Pauline Anderson
February 03, 2016
1 commentContrary to previous research, a new study suggests that benzodiazepines do not to raise the risk for dementia. However, experts caution that these medications should still be avoided in older patients because of the risk for falls and confusion.
Investigators, led by Shelly Gray, PharmD, professor and vice chair, Department of Pharmacy, University of Washington School of Pharmacy, in Seattle, found that dementia risk was slightly higher in older patients who had minimal exposure to benzodiazepines over a 10-year period. Surprisingly, higher levels of exposure were not associated with more rapid cognitive decline.
Although the study does not support a causal relationship between cumulative benzodiazepine use and dementia risk, it is not a green light to change prescribing habits, said Dr Gray.
Dr Shelly Gray
"Our study suggests that benzodiazepines may not cause dementia after all, but we still advise health professionals to avoid prescribing these medications in older people because of other adverse events, such as the increased risk for confusion or delirium, falls, car accidents, and other injuries."The study was published online February 2 in the BMJ.
Novel Findings
The analysis included 3434 participants in the Seattle area who were initially without dementia. The median age of the participants was 74 years. They had been members of Group Health, an integrated healthcare delivery system in the northwest United States, for at least 10 years.
To screen for cognitive impairment, researchers used the Cognitive Abilities Screening Instrument (CASI). Scores on the CASI range from 0 to 100, with higher scores indicating better performance. If the study participants' scores fell below a certain threshold, they underwent a thorough neuropsychiatric and medical evaluation. Experts used standard DSM-4 criteria to diagnose dementia.
The researchers ascertained patterns of exposure to benzodiazepines from Group Health's computerized pharmacy data. They selected a 10-year window and calculated a cumulative total standardized daily dose (TSDD), which reflected both dose and duration of prescriptions. Continue Reading
Posted by Phillipa on February 4, 2016, at 10:32:28
In reply to Re: Benzodiazepines: No Dementia Risk?, posted by Phillipa on February 4, 2016, at 10:28:37
A TSDD of 1 to 30 represented minimal use for up to 1 month; a TSDD of 31 to 120 represented moderate use of 1 to 4 months; a TSDD of at least 121 represented the highest and longest level of exposure.Overall, 30% of participants had filled at least one prescription for benzodiazepines in the 10 years before study entry. The most commonly used benzodiazepines were temazepam (multiple brands), diazepam (multiple brands), clonazepam (Klonapin, Roche), triazolam (Halcion, Pharmacia and Upjohn), and lorazepam (multiple brands).
During a mean of 7.3 years of follow-up, 23.2% of participants developed incident dementia; 79.9% of those cases were associated with Alzheimer's disease (AD).
There was no association between the highest level of benzodiazepine use (121 or more TSSDs) and dementia (hazard ratio [HR], 1.07; 95% confidence interval [CI], 0.83 - 1.37) or AD (HR, 0.95; 95% CI, 0.71 - 1.27) compared with nonuse.
Compared with patients who did not use benzodiazepines, there was a slightly increased risk for dementia for those with a low level of use (1 - 30 TSDDs) (HR, 1.25; 95% CI, 1.03 - 1.51) and for those who used benzodiazepines moderately (31 - 120 TSDDs) (HR, 1.31; 95% CI, 1.00 - 1.71).
For patients with AD, the increased risk was found only among those with low use.
"We were expecting to find a higher risk only in those individuals that had high use of benzodiazepines. So contrary to our expectations, we did find the small increased risk for dementia in people with low or moderate use.
"This increase probably reflects treatment of early symptoms of cognitive decline, before an actual diagnosis of dementia," said Dr Gray.
"Before being diagnosed with dementia, patients might have a period of time when they have symptoms such as anxiety, insomnia, or depression, and benzodiazepines are often used to treat those symptoms," she explained. "So the use of benzodiazepines is a consequence of the dementia, not the cause."
The investigators were unable determine the impact of the use of individual benzodiazepines on dementia risk.
The results differ from other studies, some of which have shown a link between benzodiazepine use and dementia risk. This new study is the first to use computerized pharmacy data to examine benzodiazepine use over a long period (10 years), said Dr Gray.
Another difference is in how dementia cases were determined. Previous research used administrative data to identify dementia cases.
"The problem with using administrative data is that there may be a lag in terms of when dementia is actually detected by healthcare providers," said Dr Gray.
A strength of this study is that it followed patients every 2 years to detect dementia early on.
Posted by Lamdage22 on February 4, 2016, at 11:47:37
In reply to Re: Benzodiazepines: No Dementia Risk?, posted by Phillipa on February 4, 2016, at 10:28:37
i just notice that my baseline anxiety increases if i use Lorazepam. So now i just dont.
Id take it in real emergency like dating an amazingly attractive woman i like.
Things that happen less than once a year.
Posted by Lamdage22 on February 4, 2016, at 11:48:57
In reply to Re: Benzodiazepines: No Dementia Risk?, posted by Lamdage22 on February 4, 2016, at 11:47:37
its a very slippery slope. Maybe i wont take it ever again.
There is always the temptation to take it and i dont like that at all.
Posted by Lamdage22 on February 4, 2016, at 11:50:06
In reply to Re: Benzodiazepines: No Dementia Risk?, posted by Lamdage22 on February 4, 2016, at 11:48:57
I may be more of an "addiction personality" than you are.
It just lures me.
Posted by SLS on February 4, 2016, at 14:32:31
In reply to Benzodiazepines: No Dementia Risk?, posted by Phillipa on February 4, 2016, at 10:26:03
> New study delivered to my RN newsletter now states that long term use of benzos there is no risk of dementia or Alzheimers. The other studies were wrong . I can only copy & past page one. as is two pages but will do that. Have been worried for years since been on low doses since the 70's Phillipa. Will copy & paste page one the rest is from Medscape.
I never bought into the claims that benzodiazepine (BZD) use led to Alzheimer's Dementia (AD). Still, I couldn't be sure. I just know that I would have no hesitation in using BZDs on a regular basis if they were to enhance the quality of my life.
If there is an association between BZD and AD, this might be an artifact of the disease being treated. For instance, it is now known that severe depression or anxiety carries with it a 2-3 times greater risk in the development of Alzheimer's Dementia. The people with these disorders are more likely to use BZDs as a treatment, and thus we have the likely cause for the association. It isn't the BZD that causes AD, but, rather, it is the depression and anxiety itself. BZDs might actually help prevent AD by reducing chronic stress. What would happen if you were to have severe anxiety inadequately treated because the BZD dosage was kept too low? You might end up with exactly the result reported by the study. It found that only the lower dosages were associated with AD.
Phillipa, I would not worry too much that your long-term BZD use will lead to AD.
Has your anxiety improved at all?
- Scott
Posted by Phillipa on February 4, 2016, at 15:45:30
In reply to Re: Benzodiazepines: No Dementia Risk? » Phillipa, posted by SLS on February 4, 2016, at 14:32:31
Scott I only take them at night to sleep. And have kept the doses at 10mg valium & .75 xanax for years now. During the day I am very fearful of being trapped in the house, of driving now, being alone. I must have husband with me even when getting hair done as example. And the pdoc thinks I take 1mg of xanax & the l0 of valium which in actuality only .75 of xanax. But then he has me on 50mg of luvox and only take 25 mg of that & also supposed to take 10mg of lexapro & only take 2.5mg . All the meds taken at night. But half the xanax & valium to take .25 of xanax & 5mg of valium when wake up to take synthroid middle of night. So in actuality taking 5 mg of valium when go to sleep and .5 of xanax. And the ad's. Sounds confusing I know. But have feared the Dementia so much during the last few years that take nothing during the day. Phillipa
Posted by SLS on February 4, 2016, at 16:02:23
In reply to Re: Benzodiazepines: No Dementia Risk? » SLS, posted by Phillipa on February 4, 2016, at 15:45:30
I have a question. If God told you that you would not get Alzheimer's Dementia, how would you treat yourself in order to get the maximum improvement?
How much BZD would it take for you to feel better during the day?
How much do the higher dosages of antidepressants help you?
- Scott
Posted by Phillipa on February 4, 2016, at 17:35:47
In reply to Benzodiazepines: How much do they help you? » Phillipa, posted by SLS on February 4, 2016, at 16:02:23
I have no idea as used to be able to just stop them but that was over 20 years ago. Actually before ever took an Antidepressant. Only time I remember an ad working was when took 200mg of luvox and was taking ativan? Don't remember how much ativan. This didn't last long but remember feeling good for a few weeks and getting back to wanting to do things. When only on benzos I only took when working as RN I think.25mg of xanax. All went haywire when thyroid became hypo & at the same time unknown to me was beginning menopause.Was taking .25mg 4 times a day. Then they started to just make me tired. Phillipa
Posted by Phillipa on February 4, 2016, at 19:57:05
In reply to Re: Benzodiazepines: No Dementia Risk?, posted by Lamdage22 on February 4, 2016, at 11:50:06
Lamadge opposite of you afraid of meds or any drugs. Phillipa
Posted by Phillipa on February 5, 2016, at 9:51:47
In reply to Re: Benzodiazepines: How much do they help you? » SLS, posted by Phillipa on February 4, 2016, at 17:35:47
Here is the full article from this post. Posted in BMJ. What are your thoughts on this. So many should be relieved!!! Phillipa
Posted by rjlockhart37 on February 8, 2016, at 23:49:17
In reply to Benzodiazepines: No Dementia Risk?, posted by Phillipa on February 4, 2016, at 10:26:03
i don't they could lead to nuerodegeneation, but enhance the GABA inhibitory chemical and make you feel calm all the time. On the opposite methamphetamine activates nuerons but sometimes tend to fade them out because of excessive stimulation
I was on xanax, the only thing i rerember is xanax made me want to lay down and sleep when i took it, and if i stayed up while i was on it it made me inhibited, calm not talkative, i sometimes would take d-amphetamine with alprazolam and get a calm stimulation
the only one i would think would cause cognitive issues is clonzazepam, its strong and makes people depressed........
Posted by Larry Hoover on February 9, 2016, at 7:12:04
In reply to Re: Benzodiazepines: Full article from BMJ, posted by Phillipa on February 5, 2016, at 9:51:47
> Here is the full article from this post. Posted in BMJ. What are your thoughts on this. So many should be relieved!!! Phillipa
>
>
> http://www.bmj.com/content/352/bmj.i90Thanks for the full-text.
I like the way the article was written. They thoughtfully and thoroughly discuss the strengths and weaknesses of their methodology, as well as differences between this work and earlier reports on the subject by others.
What I think is a significant finding of this study is that there appears to be a jump in benzo use in the year or two before diagnosis of dementia is made. The lowest rate of exposure to benzos in the most recent past is the most strongly associated with the risk for dementia; the 95% confidence interval is entirely above risk =1 (so any exposure is riskier than not). However, one of the first symptoms of dementia is anxiety. Another is insomnia. A third is depression. All of these can lead to a prescription for benzos.
A reasonable explanation for that connection is what is called a reverse risk. The early onset of dementia is leading to new benzo exposures.
Perhaps, and we don't know for sure, the earlier studies connecting benzo exposure to dementia were capturing this reverse risk scenario, and had insufficient data quality to tease it out.
Lar
Posted by Larry Hoover on February 9, 2016, at 7:20:39
In reply to Re: Benzodiazepines: Full article from BMJ » Phillipa, posted by Larry Hoover on February 9, 2016, at 7:12:04
Modest change in phrasing:
What I think is a significant finding of this study is that there appears to be a jump in NEW benzo use in the year or two before diagnosis of dementia is made.
By that I'm suggesting that those with the lowest exposures are not chronic users of benzos. More likely to be new users of benzos.
Lar
Posted by Phillipa on February 9, 2016, at 10:04:35
In reply to Re: Benzodiazepines: Full article from BMJ, posted by Larry Hoover on February 9, 2016, at 7:20:39
Lar, so the fact that I've been on them since age 24 and about to turn 70 doesn't mean I will get Alzheimers? As worried since the first studies were released. I do find myself making typing mistakes and finding it hard to find interest in things. And I start off being scared of being alone, get out with G and find that I head in a different direction say in the Mall and use my own money to make purchases for things I've wanted or needed for a long time.. Since don't get much from SSI I save my money and then buy it seems in bursts a few times a year of money saved up. And then he gets angry. My money? But then the loss of taste & smell added to this is also considered a symtom of Alzheimers?Phillipa
Posted by Lamdage22 on February 9, 2016, at 10:29:19
In reply to Re: Benzodiazepines: Full article from BMJ » Larry Hoover, posted by Phillipa on February 9, 2016, at 10:04:35
cognitive impairments are normal with benzos. As for Alzheimer: no idea.
This is the end of the thread.
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