Use of benzodiazepines, depressive symptoms and cognitive function in old age

Benzodiazepine use is more frequently observed in depressive and cognitively impaired subjects. The temporal relation behind this association is unknown. Here, we studied whether benzodiazepine use is associated with depressive symptoms and cognitive function and what the temporal relation underlying the associations is.

Within the Leiden 85-plus Study, a prospective population based study of 599 subjects aged 85 years at baseline, we assessed benzodiazepine use, depressive symptoms, and cognitive function annually during a 5-year follow-up period.

Benzodiazepine users were more likely to be female, be institutionalized, and have a low education. Benzodiazepine users scored 0.76 points higher on the 15-item Geriatric Depression Scale than non-users (95% CI: 0.27-1.25, p = 0.002). They were 1.6-fold more likely to develop new depressive symptoms in 1 year when compared to non-users (95% CI: 1.05-2.55, p = 0.028). Benzodiazepine use did not associate with cognitive function, but discontinued benzodiazepine users had a 4.0 points lower Mini Mental State Examination (MMSE) score in the year before discontinuation than continued benzodiazepine users (95% CI: 1.31-6.73, p = 0.004).

In old age the use of benzodiazepines is associated with depressive symptoms and the use of benzodiazepines may precede the development of depressive symptoms. Treating physicians seem to be aware of the detrimental effects of benzodiazepines on cognitive function. However, they should be cautious in prescribing a new benzodiazepine in old age and monitor elderly benzodiazepine users for development of depressive symptoms.