Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life
Older adults and withdrawal from benzodiazepine hypnotics in general practice: effects on cognitive function, sleep, mood and quality of life
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DOI：
10.1017/s0033291703008213
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发表时间：
2003-10-01
影响因子：
6.9
通讯作者：
Iliffe, S
中科院分区：
文献类型：
--
作者：
Curran, HV;Collins, R;Iliffe, S
背景老年人是苯二氮卓类（BZD）催眠药重复处方的主要接受者。BZD可损害认知功能，连续服用数年可能无法帮助睡眠。因此，本研究旨在确定停用BZD是否会导致患者认知功能、生活质量、情绪和睡眠的变化。在25个一般性实践中确定了192名年龄大于或等于65岁的BZD催眠药长期使用者。在双盲、安慰剂对照条件下，将104名希望退出的患者随机分配到两组中的一组：A组的BZD剂量从试验第1周开始逐渐减少; B组给予其常规剂量12周，然后逐渐减少。另外一组（C）35名不希望退出BZD的患者作为“继续者”参加。所有患者在0、12和24周进行评估，50%的患者在52周进行重新评估。60%的患者连续服用BZD> 10年; 27%的患者连续服用BZD> 20年。在所有开始试验的患者中，80%在6个月后成功退出。A组和B组之间几乎没有差异，但这些组与继续者（C）的不同之处在于，退出者在几项认知/心理任务上的表现在24周或52周时显示出相对改善。戒断者和持续者在睡眠或BZD戒断症状方面没有差异。这些结果对临床实践有明确的意义。戒断BZD对老年人产生了一些微妙的认知优势，但几乎没有戒断症状或紧急睡眠困难。这些发现还表明，长期服用BZD并不能帮助睡眠。
Background. Older adults are the main recipients of repeat prescriptions for benzodiazepine (BZD) hypnotics. BZDs can impair cognitive function and may not aid sleep when taken continuously for years. This study therefore aimed to determine if withdrawing from BZDs leads to changes in patients' cognitive function, quality of life, mood and sleep.Method. One hundred and ninety-two long-term users of BZD hypnotics, aged greater than or equal to65 years, were identified in 25 general practices. One hundred and four who wished to withdraw were randomly allocated to one of two groups under double-blind, placebo controlled conditions: group A's BZD dose was tapered from week 1 of the trial; group B were given their usual dose for 12 weeks and then it was tapered. An additional group (C) of 35 patients who did not wish to withdraw from BZDs participated as 'continuers'. All patients were assessed at 0, 12 and 24 weeks and 50% were reassessed at 52 weeks.Results. Sixty per cent of patients had taken BZDs continuously for > 10 years; 27% for > 20 years. Of all patients beginning the trial, 80% had successfully withdrawn 6 months later. There was little difference between groups A and B, but these groups differed from continuers (C) in that the performance of the withdrawers on several cognitive/psychomotor tasks showed relative improvements at 24 or 52 weeks. Withdrawers and continuers did not differ in sleep or BZD withdrawal symptoms.Conclusions. These results have clear implications for clinical practice. Withdrawal from BZDs produces some subtle cognitive advantages for older people, yet little in the way of withdrawal symptoms or emergent sleep difficulties. These findings also suggest that, taken long-term, BZDs do not aid sleep.