Paradoxical reactions to benzodiazepines in the elderly

Area of Science:

• Pharmacology
• Geriatrics
• Neuroscience

Background:

• Benzodiazepines can cause paradoxical reactions, affecting approximately 1% of the general population.
• Advanced age and cognitive disorders are known risk factors for these adverse effects.
• Existing literature inadequately addresses the prevalence and presentation of paradoxical reactions in the elderly and those with neurocognitive disorders.

Purpose of the Study:

• To review the literature on paradoxical reactions to benzodiazepines, with a specific focus on the elderly and patients with neurocognitive disorders.
• To investigate the potential underreporting or misdiagnosis of these reactions in at-risk populations.
• To emphasize the importance of recognizing paradoxical reactions to mitigate iatrogenic harm.

Main Methods:

• A comprehensive literature review was conducted.
• The review focused on studies examining benzodiazepine-induced paradoxical reactions, particularly in elderly individuals and those with neurocognitive impairments.
• Analysis of reported semiology and risk factors was performed.

Main Results:

• A limited number of studies were identified concerning the elderly (few articles) and patients with neurocognitive disorders (only one article).
• The semiology of paradoxical reactions can be diverse and may be mistaken for symptoms of underlying neurocognitive disorders.
• There is a significant risk of iatrogeny due to the under-recognition of these reactions.

Conclusions:

• The low number of studies suggests potential underreporting or misdiagnosis of paradoxical reactions in vulnerable populations.
• The elderly and individuals with neurocognitive disorders may be at a higher risk than currently documented.
• Sudden onset of aggressive behaviors (self- or hetero-aggressive) is a key semiological indicator requiring prompt clinical suspicion and evaluation.