Effects of discontinuing benzodiazepine-derivative hypnotics on postural sway and cognitive functions in the elderly.
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.
Tsunoda
Kenichi
K
Department of Psychiatry, Minamihanno Hospital, Saitama, Japan.
Uchida
Hiroyuki
H
Suzuki
Takefumi
T
Watanabe
Koichiro
K
Yamashima
Tetsumori
T
Kashima
Haruo
H
D000368:Aged; D000369:Aged, 80 and over; D003071:Cognition / Q000187:drug effects*; D005260:Female; D005425:Flicker Fusion / Q000187:drug effects; D005479:Flurazepam / Q000627:therapeutic use*; D015577:Geriatric Assessment; D006801:Humans; D006993:Hypnotics and Sedatives / Q000627:therapeutic use*; D008297:Male; D009483:Neuropsychological Tests; D004856:Postural Balance / Q000187:drug effects*; D012890:Sleep / Q000187:drug effects; D011795:Surveys and Questionnaires
D006993:Hypnotics and Sedatives; D005479:Flurazepam