A Saint Louis University study reveals that anxiety increases dementia risk by 19% in seniors, and benzodiazepines add a 28% risk, though they don’t affect patients with anxiety disorders. Further research is needed to explore these associations.
Research at Saint Louis University School of Medicine highlights a significant association between anxiety and an increased risk of dementia in seniors, with benzodiazepine exposure further elevating this risk by 28%.
Research from Saint Louis University School of Medicine finds that among patients 65 and older, a diagnosis of anxiety was significantly associated with an increased risk of dementia diagnosis, and benzodiazepine exposure was associated with a 28% increased risk of dementia. However, when benzodiazepines were prescribed to patients with an anxiety disorder, there was no significant association between these medications and incident dementia.
The study, “Anxiety Disorders, Benzodiazepine Prescription and Incident Dementia,” was published in the Journal of the American Geriatrics Society.
Benzodiazepines are a group of medications often used to help calm the nerves and reduce anxiety. These drugs work by slowing down the brain’s activity, which helps ease the mind and relax the body. Some of the well-known benzodiazepines include Alprazolam (also known as Xanax), Diazepam (commonly called Valium), and Lorazepam (known as Ativan), all of which are primarily used to manage anxiety symptoms.
Study Findings
Jay A. Brieler, M.D., associate professor of family and community medicine at SLU, is the paper’s first author. Jeffrey Scherrer, Ph.D., professor of family and community medicine and a member of the AHEAD Institute, is the senior author.
The study’s authors found while there is an association between anxiety and dementia, and an association between benzodiazepines and dementia, there is no association between these medications and dementia when prescribed to persons with an anxiety disorder.
The Controversial Role of Benzodiazepines
It is unknown whether treating late-life anxiety disorders with benzodiazepines exposes patients to additional risks of dementia. Anxiety in older adults can be linked with cardiovascular disease, diabetes, depression, social withdrawal, physical inactivity, sleep disturbance, smoking, obesity, alcohol consumption, and chronic disease burden.
Benzodiazepine prescriptions for older patients are controversial. Their use has been associated with short-term cognitive impairment, falls, and fractures. Per Dr. Brieler,
“As a clinician who frequently treats patients with anxiety disorders, recent studies suggesting benzodiazepine use could contribute to dementia were very concerning to me,” Brieler said. “I had the assumption that if a benzodiazepine was used and side effects occurred, simply stopping the medication would remedy the problem over time.
“The difficult issue with those studies is that anxiety itself is also associated with dementia. It was still unclear from the literature whether the disease or the treatment was the culprit. Based on our work, it appears that both are playing a part, but it remains uncertain how the two interact with each other.”
Insights From Extensive Patient Data
This retrospective cohort study reviewed the electronic health data of 72,496 patients from 2014-21.
The de-identified medical record data was obtained from the Saint Louis University-SSM Healthcare System’s Virtual Data Warehouse (VDW). The VDW, created and maintained by the Advanced HEAlth Data (AHEAD) Research Institute at Saint Louis University, captures clinical encounters starting from Jan. 1, 2008, from academic and non-academic ambulatory and inpatient settings in the Midwest.
The VDW includes more than 5 million patients from birth to 90 years of age who have utilized services in the healthcare system since 2008.
Eligible patients were 65 years of age or older, had clinic encounters before and after index and were free of dementia for two years prior to index date. Of the cohort, 85.6% were white and 59.9% were female. The median age was 74.
Five million Americans 65 or older had an Alzheimer’s or related dementia diagnosis in 2014, which is expected to double by 2060.
“This study is a great example of using real-world clinical data to examine research questions that otherwise would not be practical to investigate,” Scherrer said. “We do not have the resources to follow tens of thousands of patients over time. We overcame that obstacle by using the VDW and expertise available in the AHEAD Institute.”
Key Study Takeaways and Recommendations
- Anxiety was associated with a 19% increased risk of incident dementia independent of sustained benzodiazepine use.
- Sustained benzodiazepine use was associated with a 28% increased risk of dementia.
- Sustained benzodiazepine use among those with anxiety disorder did not lower or increase the risk of dementia.
- Literature determining an independent association between anxiety and benzodiazepines with incident dementia is inclusive.
The authors recommend further studies to determine if the association with incident dementia varies across other anxiety medications.
Reference: “Anxiety disorders, benzodiazepine prescription, and incident dementia” by Jay A. Brieler, Joanne Salas, Matthew E. Amick, Poorva Sheth, Elizabeth A. Keegan-Garrett, John E. Morley and Jeffrey F. Scherrer, 28 July 2023, Journal of the American Geriatrics Society.
DOI: 10.1111/jgs.18515
Funds to maintain the Virtual Data Warehouse came from the Saint Louis University Research Institute. Saint Louis University is a member of the Health Care Systems Research Network.
Other authors include Joanne Salas, MPH, of the Department of Family and Community Medicine at Saint Louis University, Harry S. Truman Veterans Administration Medical Center, Columbia, Mo., and the Advanced HEAlth Data (AHEAD) Research Institute at SLU; Matthew E. Amick, Poorva Sheth, Elizabeth A. Keegan-Garrett, M.D., of the Department of Family and Community Medicine at Saint Louis University; and John Morley, MBBCh., of the AHEAD Institute at SLU.
