title: Effect of withdrawal from long-term use of temazepam, zopiclone or zolpidem as hypnotic agents on cognition in older adults.
abstract: OBJECTIVE
  The aim of this study was to assess the effect of withdrawal from the long-term use of temazepam, zopiclone or zolpidem as hypnotics drugs (here referred to as BZD) on cognitive performance.
  
  
  METHODS
  Ninety-two adults (age ≥55 years) with primary insomnia and who were long-term daily users of BZD volunteered to participate in a 1-month medically supported withdrawal attempt from BZD use, with a subsequent 5-month follow-up. Withdrawal was based on plasma BZD measurements at baseline, at 1 month and during subsequent regular clinical appointments. Attention and psychomotor performance were measured using the CogniSpeed® at baseline and at 1, 2 and 6 months. Reaction times were determined in the Simple Reaction Time (SRT), Two-Choice Reaction Time (2-CRT) and Vigilance tests, and errors were measured by the 2-CRT and Vigilance tests. The cognition data of the withdrawal group were also compared with a cohort of BZD non-users.
  
  
  RESULTS
  Eighty-nine (97 %) participants (59 women, 30 men) were followed-up for a maximum of 6 months. During the follow-up period, changes in reaction times and errors did not differ between short-term withdrawers (no residual BZD at 1 month; N = 69), non-withdrawers (residual BZD at 1 month; N = 20) or long-term withdrawers (N = 34). Compared to the reaction times of the BZD-free cohort, those of BZD users were slower at baseline. The reaction times of BZD withdrawers based on the results of the SRT or 2-CRT tests during follow-up did not reach those of the BZD-free cohort, but there was no difference between these groups in the Vigilance test.
  
  
  CONCLUSIONS
  Long-term use of BDZ as hypnotic drugs by older adults is related to prolonged impairment of attentional and psychomotor cognitive functioning that persists for at least 6 months after withdrawal.
authors: Department of Family Medicine, University of Turku, Lemminkäisenkatu 1, 20014, Turku, Finland, juhpuu@utu.fi.
authors: Juha
authors: J
authors: Puustinen
authors: Ritva
authors: R
authors: Lähteenmäki
authors: Päivi
authors: P
authors: Polo-Kantola
authors: Paula
authors: P
authors: Salo
authors: Tero
authors: T
authors: Vahlberg
authors: Alan
authors: A
authors: Lyles
authors: Pertti J
authors: PJ
authors: Neuvonen
authors: Markku
authors: M
authors: Partinen
authors: Ismo
authors: I
authors: Räihä
authors: Sirkka-Liisa
authors: SL
authors: Kivelä
mesh_terms: D000368:Aged; D053961:Azabicyclo Compounds / Q000008:administration & dosage / Q000009:adverse effects*; D003071:Cognition / Q000187:drug effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006993:Hypnotics and Sedatives / Q000008:administration & dosage / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D010879:Piperazines / Q000008:administration & dosage / Q000009:adverse effects*; D011597:Psychomotor Performance / Q000187:drug effects; D011725:Pyridines / Q000008:administration & dosage / Q000009:adverse effects*; D011930:Reaction Time / Q000187:drug effects; D007319:Sleep Initiation and Maintenance Disorders / Q000188:drug therapy; D013375:Substance Withdrawal Syndrome / Q000523:psychology*; D013693:Temazepam / Q000008:administration & dosage / Q000009:adverse effects*; D013997:Time Factors; D000077334:Zolpidem
chemical_list: D053961:Azabicyclo Compounds; D006993:Hypnotics and Sedatives; D010879:Piperazines; D011725:Pyridines; C515050:zopiclone; D000077334:Zolpidem; D013693:Temazepam