Insomnia affects over half of elderly people. This greatly impacts their quality of life and how they function. Left untreated, insomnia causes depression and anxiety and is associated with hypertension, heart disease and even stroke. Yet, insomnia is largely unaddressed by their health care providers. When it is addressed, benzodiazepines like valium, Ativan and Klonopin are commonly prescribed. An unresolved controversy has been whether long-term use of benzodiazepines increase the risk of dementia. There have been numerous studies with conflicting results.
In a retrospective study of patients from data collected between 1991 and 2008, 13% of participants developed dementia during an average followup of 11 years. There was no significant increased risk of developing dementia when the group taking benzodiazepines was compared with those who had never used benzodiazepines. In a study of brain morphology using brain MRI imaging in almost 5000 patients, however, there was a significantly increased brain atrophy (shrinkage of the brain) with an overall lower total brain volume and lower volume in specific areas of the brain (hippocampus, amygdala, and thalamus). Interestingly, there was no difference between the type and doses of the benzodiazepine used.
Some experts fear that beyond volume loss there may also be a reduced neuroplasticity (forming and reorganizing connections between nerve cells in the brain during learning or in response to injury) with chronic benzodiazepine use. There is also concern that long-term use of benzodiazepines reduce the number of receptors for neurotransmitters (like GABA) which are the means for communication between nerve cells. This
can potentially lead to impairment in memory, mood, and learning-the functions of the specific regions most affected by volume loss (the hippocampus and amygdala).
There are, of course, other potential dangers associated from chronic benzodiazepine use in the elderly, such as increased fall risk, interactions with other medications and withdrawal if stopped abruptly. While there are other medications available to treat the elderly for insomnia, each carries with it its own set of potential side effects. Further, may clinicians are not well-versed in the newer options. Clearly, treatment of insomnia is very important. The jury is still out on the increased risk of dementia from benzodiazepine use. The bottom line is that the decision to treat insomnia and with what medication has to be made for each individual.
BeCare Neuro App can help by monitoring for the possible associated cognitive impairment and increased fall risk, both in untreated insomniacs and those being treated with benzodiazepines.
