Journal of the American Medical Directors Association
Original StudyCognitive Outcomes of Long-term Benzodiazepine and Related Drug (BDZR) Use in People Living With Mild to Moderate Alzheimer's Disease: Results From NILVAD
Section snippets
Methods
This is a longitudinal analysis of data from NILVAD, a Europe-wide, multicenter randomized clinical trial of the antihypertensive nilvadipine in mild to moderate AD. We examined the relationship between ongoing BDZR use and cognitive function at 18-month follow-up in addition to the effect of BDZR use on adverse events, delirium, and falls at 18 months.
Study Participants
Of 448 participants, just under two-thirds (62.28%) were female and mean age was 72.46 years [standard deviation (SD) 8.2]. Median number of years since AD diagnosis was 1.09 years [interquartile range (IQR) 0.47-2.26] and the median years since AD symptom onset was 3.7 years (IQR 2.45-5.42). In terms of cognitive profile, the median MMSE score of included patients at initial assessment was 21 (IQR 18-24) and the mean baseline ADAS-Cog score was 34.08 (SD 10.53). Based on initial MMSE
Discussion
This is the first study to our knowledge to assess the cognitive consequences of ongoing BDZR use in patients with mild to moderate AD. We found no association between ongoing BDZR use and cognitive scores (ADAS-Cog) at 18 months. However, ongoing use of BDZR medication was associated with adverse events, incident delirium, and falls. Thus, consistent with previous literature, these results support avoidance of BDZR drugs (where possible) in older adults with AD.
The prevalence of ongoing BDZR
Conclusion and Implications
The current study found that ongoing BDZR use in those with mild to moderate AD was not associated with accelerated cognitive decline. However, use was significantly associated with adverse events, incident delirium, and falls. Our results add to the mounting evidence of the adverse consequences of ongoing BDZR use in this population and support previous guidelines aimed at discontinuation in older adults, particularly in those with AD.
Acknowledgments
NILVAD Study Group
Brian Lawlor, Mercer's Institute for Research on Ageing, St. James's Hospital and Department of Medical Gerontology, Trinity College, Dublin, Ireland; Ricardo Segurado, CSTAR and School of Public Health, Physiotherapy and Sport Science, University College Dublin (UCD), Dublin, Ireland; Sean Kennelly, Department of Age Related Healthcare, Tallaght Hospital, Dublin 24, and Department of Medical Gerontology, Trinity College Dublin; Marcel G. M. Olde Rikkert, Department of
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Funding from the NILVAD study was from the European Commission Framework 7 Programme Health Theme Collaborative Project (grant 279093; PI: Brian Lawlor).
The authors declare no conflicts of interest.
The full author list of the NILVAD Study Group is listed at the end of the article.