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Benzodiazepine Use and Cognitive Decline in Elderly With Normal Cognition

Zhang, Yuhai PhD; Zhou, Xiao-hua PhD; Meranus, Dana H. PhD; Wang, Linbo BS; Kukull, Walter A. PhD

Alzheimer Disease & Associated Disorders: April-June 2016 - Volume 30 - Issue 2 - p 113–117
doi: 10.1097/WAD.0000000000000099
Original Articles

Benzodiazepine (BZD) use may be associated with dementia. However, differing opinions exist regarding the effect of BZDs on long-term changes in cognition. We evaluated the association between BZD use and cognitive decline in the elderly with normal cognition from the National Alzheimer’s Disease Coordinating Center’s Uniform Data Set. The study exposure, BZD use, was classified 2 ways: any-use [reported BZD use at a minimum of 1 Alzheimer's disease center (ADC) visit] and always-use (reported BZD use at all ADC visits). The reference group included participants without any declared BZD use at any Alzheimer's Disease Center (ADC) visit. The main outcome measures were Clinical Dementia Rating Sum of Boxes score and Mini-Mental State Examination score. We observed a decline in cognitive status over time in the 2 comparison groups. All participants who reported taking BZDs had poorer cognitive performance at all visits than nonusers. However, cognitive decline was statistically similar among all participants. We found no evidence of an association between BZD use and cognitive decline. The poor cognitive performance in BZD users may be due to prodromal symptoms caused by preclinical dementia processes.

Departments of *Biostatistics

Epidemiology, School of Public Health, University of Washington

HSR &D VA Puget Sound Health Care System

§National Alzheimer’s Coordinating Center, Seattle, WA

Department of Health Statistics, School of Public Health, Fourth Military Medical University, Xi’an, China

The NACC database is funded by NIA/NIH Grant U01 AG016976. NACC data are contributed by the NIA-funded ADCs: P30 AG019610 (PI: Eric Reiman, MD), P30 AG013846 (PI: Neil Kowall, MD), P50 AG008702 (PI: Scott Small, MD), P50 AG025688 (PI: Allan Levey, MD, PhD), P30 AG010133 (PI: Andrew Saykin, PsyD), P50 AG005146 (PI: Marilyn Albert, PhD), P50 AG005134 (PI: Bradley Hyman, MD, PhD), P50 AG016574 (PI: Ronald Petersen, MD, PhD), P50 AG005138 (PI: Mary Sano, PhD), P30 AG008051 (PI: Steven Ferris, PhD), P30 AG013854 (PI: M. Marsel Mesulam, MD), P30 AG008017 (PI: Jeffrey Kaye, MD), P30 AG010161 (PI: David Bennett, MD), P30 AG010129 (PI: Charles DeCarli, MD), P50 AG016573 (PI: Frank LaFerla, PhD), P50 AG016570 (PI: David Teplow, PhD), P50 AG005131 (PI: Douglas Galasko, MD), P50 AG023501 (PI: Bruce Miller, MD), P30 AG035982 (PI: Russell Swerdlow, MD), P30 AG028383 (PI: Linda Van Eldik, PhD), P30 AG010124 (PI: John Trojanowski, MD, PhD), P50 AG005133 (PI: Oscar Lopez, MD), P50 AG005142 (PI: Helena Chui, MD), P30 AG012300 (PI: Roger Rosenberg, MD), P50 AG005136 (PI: Thomas Montine, MD, PhD), P50 AG033514 (PI: Sanjay Asthana, MD, FRCP), and P50 AG005681 (PI: John Morris, MD).

This study was supported by the State Scholarship Fund of China and the National Natural Science Foundation of China (30901241).

The authors declare no conflicts of interest.

Reprints: Xiao-hua Zhou, PhD, Department of Biostatistics, School of Public Health, University of Washington, P.O. Box 357232, Seattle, WA 98195 (e-mail:

Received July 14, 2014

Accepted April 28, 2015

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