EVIDENCE LIBRARY
Alzheimer Benzodiazepine Review Found Agitation Evidence Did Not Establish Better Sleep
A systematic review found limited evidence of benefit in Alzheimer’s disease and no demonstrated improvement in sleep quality. Its findings varied by outcome and study design.
A systematic review found limited evidence of benefit in Alzheimer’s disease and no demonstrated improvement in sleep quality. Its findings varied by outcome and study design.
The evidence reviewed
Defrancesco and colleagues searched literature from 1983 through January 2015. Eighteen studies met their criteria: eight concerned frequency of use, five cognitive outcomes, and five behavioral or sleep outcomes. Reported benzodiazepine use ranged from 8.5% to 20% across the included populations.
Two studies reported benefit from lorazepam or alprazolam for agitation. Five reported associations with faster cognitive deterioration. These findings came from different studies and should not be combined as though one controlled trial demonstrated both effects.
Why indication matters
Improved management of acute agitation does not demonstrate improved sleep or long-term cognitive safety. The review found no conclusive sleep benefit, while noting a shortage of high-quality controlled trials. Many included studies were open-label or observational.
Co-prescribed psychotropics, differing dementia definitions, patient selection, and restricted searching reduced comparability. Associations with cognitive decline could reflect differences in the people selected for treatment as well as possible medication effects.
Applying the review carefully
In a chart assessment, identify the symptom being treated, the timing of treatment, other sedating medicines, and the observed outcome. This historical review does not establish that benzodiazepines caused Alzheimer’s disease or that a particular prescription was inappropriate under every circumstance.
Source
Original analysis of the supplied paper: Use of Benzodiazepines in Alzheimer s Disease A Systematic Review of Literature. Paper identifier: PMC4648159.