Picton Jenna D, Marino Adriane Brackett, Nealy Kimberly Lovin
Lahey Hospital & Medical Center, Burlington, MA
Carolinas HealthCare System, Lincolnton, NC.
Am J Health Syst Pharm. 2018 Jan 1;75(1):e6-e12. doi: 10.2146/ajhp160381.
Published evidence on the relationship between benzodiazepine exposure and altered cognition in the geriatric population is reviewed.
Benzodiazepines constitute one of the most commonly prescribed medication classes and are used primarily for management of anxiety and insomnia. Despite strong recommendations based on high-quality evidence warning of the potential cognitive adverse effects of benzodiazepine use, particularly in patients 65 years of age or older, published literature suggests that a substantial proportion of the U.S. geriatric population use these medications in a chronic fashion. The body of evidence suggesting that benzodiazepine use may be a modifiable risk factor for dementia continues to grow. Evidence exists to suggest that benzodiazepine use in the elderly population is associated with cognitive decline, dementia, and Alzheimer's disease, although evidence regarding the correlation between benzodiazepine use and dementia is conflicting; the more recent studies in this area have focused on eliminating causation bias. Pharmacists in a variety of settings can educate patients and assist providers in selecting an appropriate medication regimen for anxiety or insomnia that is tailored to each elderly patient's needs and takes into account the immediate and long-term safety of the patient.
Investigations of the association between benzodiazepine therapy and cognitive decline in elderly patients have yielded mixed findings. Stronger links have emerged from studies examining longer- rather than shorter-acting benzodiazepines, longer rather than shorter durations of use, or earlier rather than later exposure. Questions remain about causality and the impact of confounders on study interpretation.
综述已发表的关于老年人群中苯二氮䓬类药物暴露与认知改变之间关系的证据。
苯二氮䓬类药物是最常被处方的药物类别之一，主要用于治疗焦虑和失眠。尽管基于高质量证据有强烈建议警告使用苯二氮䓬类药物可能产生认知不良反应，特别是在65岁及以上的患者中，但已发表的文献表明，美国很大一部分老年人群长期使用这些药物。提示苯二氮䓬类药物使用可能是痴呆可改变风险因素的证据不断增加。有证据表明老年人群使用苯二氮䓬类药物与认知衰退、痴呆和阿尔茨海默病有关，尽管关于苯二氮䓬类药物使用与痴呆之间相关性的证据存在矛盾；该领域最近的研究集中于消除因果偏差。各种环境中的药剂师可以对患者进行教育，并协助医疗服务提供者为焦虑或失眠选择适合每位老年患者需求并考虑到患者近期和长期安全的适当药物治疗方案。
关于苯二氮䓬类药物治疗与老年患者认知衰退之间关联的调查结果不一。在研究长效而非短效苯二氮䓬类药物、较长而非较短使用时长或较早而非较晚暴露时发现了更强的联系。关于因果关系以及混杂因素对研究解释的影响仍存在疑问。
