Saarelainen and colleagues published the results of their retrospective cohort study online in November in the International Journal of Geriatric Psychiatry. The authors looked at all-cause 180 day mortality in Alzheimer’s disease patients living in the community and associations with benzodiazepine and related drugs (Z-drugs) use.

Although guidelines advocate only short-term use of benzodiazepines and related drugs for behavioural and psychological symptoms of dementia, the authors state that up to a third of Alzheimer’s patients are using these agents. Medications included in the study were diazepam, chlordiazepoxide, oxazepam, lorazepam, alprazolam, nitrazepam, temazepam, zopiclone and zolpidem.

The age-adjusted death rate per 100 person-years was 13.4 for users and 8.5 for non-users. The association between increased risk of death with the drugs was significant for bendodiazepines, but not for the Z-drugs, and did nor persist beyond 120 days.

While there are limitations to retrospective studies, the associations are plausible and underscore the fact that CNS depressants should generally be avoided in patients with Alzheimer’s disease as they decrease cognitive function, increase the risk of falls (which can be catastrophic) and may aggravate sleep-disordered breathing.