Lapeyre-Mestre Maryse
UMR Inserm 1027, CIC 1436, pharmacologie médicale et clinique, faculté de médecine, CHU de Toulouse, université Paul-Sabatier - Toulouse 3, 37, allées Jules-Guesde, 31000 Toulouse, France.
Therapie. 2019 Jun;74(3):407-419. doi: 10.1016/j.therap.2018.09.071. Epub 2018 Oct 3.
Benzodiazepines are a source of well-known adverse reactions related to their pharmacological properties: memory disorders, falls in the elderly, confusion and sedation, drug addiction. The impact of their chronic use on cognitive decline and dementia has been the subject of many studies for two decades.
From 25 studies identified in the international literature from 1997 to 2017, the Bradford-Hill causality criteria were systematically applied.
Fifteen studies found a statistically significant association with a deleterious effect, two a protective effect and eight did not find any association. The most recent studies using a longer delay to take into account a protopathic bias did not find any association or any dose-effect relationship. The majority of studies suggest impaired cognitive functions for contemporary consumption or those closest to the event being studied. Finally, the biological plausibility remains discussed.
The question of the role of benzodiazepines in the onset of dementia remains open, and other studies attempting to limit previous methodological drawbacks should be carried out.
苯二氮䓬类药物因其药理学特性会引发一些众所周知的不良反应，如记忆障碍、老年人跌倒、意识模糊和镇静作用、药物成瘾。二十年来，其长期使用对认知能力下降和痴呆症的影响一直是众多研究的主题。
系统应用布拉德福德-希尔因果关系标准，对1997年至2017年国际文献中确定的25项研究进行分析。
15项研究发现存在统计学显著关联且具有有害影响，2项研究发现有保护作用，8项研究未发现任何关联。最近考虑到原发病偏倚而采用更长时间间隔的研究未发现任何关联或剂量效应关系。大多数研究表明，当代使用或与所研究事件时间最接近时使用苯二氮䓬类药物会损害认知功能。最后，生物学合理性仍存在争议。
苯二氮䓬类药物在痴呆症发病中的作用问题仍未解决，应开展其他研究以试图克服先前的方法学缺陷。
