Drugs like Valium and Klonopin may increase the risk of stroke and hip fractures. Here’s what you should know about benzos and dementia.
When your aunt with Alzheimer’s disease becomes anxious or agitated, or can’t sleep at night, a medication to calm her down may seem a kindness. However, the most common anti-anxiety drugs, the benzodiazepines, may not really help — and also increase her chance of a stroke or breaking her hip.
Doctors frequently prescribe benzodiazepines — especially the brand-names alprazolam (Xanax), clonazepam (Klonopin), lorazepam (Ativan), and diazepam (Valium) — to treat insomnia and anxiety. Some 9 to 12 percent of older adults in the United States take one. Often their doctors tell them to use the drug only as needed — and just for a short time, during a rough patch. But with age, people tend to use more of these medications and are more likely to stay on them, with no plans to stop.
Benzos and dementia
Among Alzheimer’s patients, as many as one in five may take a benzodiazepine, according to a 2015 meta-analysis, and that number rises much higher in nursing homes or special care units.
Their usefulness may seem to outweigh the risks of side effects. Until recently, for example, there was no known link between benzodiazepines and stroke or other kinds of heart problems.
That changed with a 2017 study based on nationwide data in Finland, in which researchers found evidence linking the drugs to a 20 percent increase in the risk of stroke among Alzheimer’s patients. The data included more than 45,000 people diagnosed with Alzheimer’s, of whom 22 percent used a benzo or related drug during the five-year study period.
Stroke is one of the leading causes of death among people with Alzheimer’s. Getting back to your aunt, you might make sure her doctors have evaluated all her risk factors for stroke. Does she have a personal or family history of the disease, high blood pressure, type 2 diabetes, or other heart issues?
The same Finnish team found a link between these drugs and hip fractures, especially in the first six months after starting the drug. Overall, in the five-year study, the team reported 43 percent more hip fractures among patients who used the meds, compared to those who didn’t. And the patients taking a benzo were more likely to need to stay in the hospital longer than usual to recover from the hip fracture.
What you can do
If your aunt is already taking a benzo, do you have good reasons to believe it is helping her? Some people stay on benzos because of side effects when they try to stop — not because the benefits are clear. The Austrian team that reported on the prevalence of benzodiazepine prescriptions among Alzheimer’s patients also concluded that the evidence that these drugs actually help dementia patients sleep or reduce anxiety is weak. You might ask your aunt’s doctors to consider other options. For example, this study reported better evidence that the popular antidepressant citalopram (Celexa) soothed agitated Alzheimer’s patients. It also pointed to research backing galantamine (Razadyne) and risperidone (Risperdal) as effective, common treatments for dementia patients who are very agitated.
Some research suggested that taking benzos could actually increase your chance of developing Alzheimer’s, but later studies did not confirm that finding.
Beyond being sure she’s been evaluated for all the available drugs, you can help your aunt relax the same ways we all do. One of the best moves: make sure you or her caregivers get her out of her chair and supervise while she walks around the neighborhood or on a treadmill or cycles on a stationary bike. Exercise can slow mental decline in dementia patients, research indicates, and it has proven benefits to reduce anxiety and promote sleep for everyone. One 2016 study suggests that a routine of moderate intensity exercise can even relieve symptoms of serious anxiety problems like panic disorder or agoraphobia.
You can also give her the gift of music: bring earphones and a music player loaded with upbeat or soothing music you know she enjoys. Early research suggests that the right music can reduce anxiety in dementia patients.
March 16, 2020
Christopher Nystuen, MD, MBA