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Growing evidence of a link between benzodiazepines and Alzheimer’s disease in older adults warrants concern and caution, say clinicians from the Cleveland Clinic Akron General, Akron, OH, in a new review.

There is no evidence that benzodiazepines (including tranquilizers such as Xanax) cause dementia, the investigators said. But the drug’s association with poor cognitive outcomes and frequent use of benzodiazepines among older adults should prompt clinicians to remain wary when prescribing the drug to this population, contend Rajesh R. Tampi, M.D., and Adriane Bennett, Ph.D, in an article in Psychiatric Times.

The reviewers — a psychiatrist and a psychologist — found that more than half of the qualified studies they examined (53%) tied benzodiazepine use to the development of dementia. Other studies found no relationship or mixed results, but one investigation also revealed that nearly half of the prescriptions for benzodiazepine among older adults are potentially inappropriate.

Meanwhile, concerns have risen about long-term use, dangerous combinations with other drugs, and association with falls and dependence in the elderly.

An Athena Health Group study (not related to the current review) in 2016 found that prescriptions continue to rise as patients age, peaking after age 65. What’s more, older women are prescribed benzodiazepines at nearly twice the rate as their male peers, the study found. 

A Canadian study published in April 2020 found that two in three seniors leave the hospital with new drug prescriptions that increase the odds of experiencing an adverse drug event. And the most commonly prescribed of these medicines include benzodiazepines and proton pump inhibitors.

The Food and Drug Administration had some of these problems in mind in September, when it required benzodiazepine drug labels to display its most serious “boxed warning.” 

“Despite the lack of evidence proving causality, the association between benzodiazepine use and the development of dementia is a major cause for concern given the prevalence of benzodiazepine use among older adults,” concluded Tampi and Bennett. “The prescription of benzodiazepines to older adults must be carefully reviewed given the lack of data regarding their long-term efficacy and their significant adverse effects including the risk for developing dementia.”