Confusion and hypnotics in demented patients

Area of Science:

• Gerontology
• Pharmacology
• Clinical Neurology

Background:

• Elderly patients, particularly those with dementia, are often prescribed hypnotics.
• There is a concern that hypnotics may exacerbate confusion or that these patients are more sensitive to their effects.

Purpose of the Study:

• To investigate the effects of common hypnotics (chlormethiazole, temazepam) compared to placebo in elderly patients with confusion.
• To determine if demented patients exhibit increased sensitivity to hypnotic drug effects.

Main Methods:

• A randomized, placebo-controlled, crossover study involving eleven elderly confused patients.
• Patients received single doses of chlormethiazole, temazepam, and placebo on separate nights.
• Cognitive function, orientation, and hangover effects were assessed the following morning using subjective and objective measures.

Main Results:

• No statistically significant differences were observed in mental ability, orientation, or hangover effects between chlormethiazole, temazepam, and placebo.
• Plasma drug concentrations were approximately double in demented patients compared to normal elderly subjects.
• A weak correlation was found between plasma drug concentration and observed pharmacological effects.

Conclusions:

• The findings do not support the hypothesis that hypnotics worsen confusion or that demented patients are more sensitive to their actions.
• Higher plasma concentrations in demented patients suggest a potential for decreased sensitivity rather than increased sensitivity.
• Further research is needed to understand the pharmacokinetics and pharmacodynamics of hypnotics in elderly patients with cognitive impairment.