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Use caution with drugs for dementia symptoms: Dr. Paula Rochon

April 17, 2017

By Lindsay Jolivet

Scientists have found that a type of drug used to treat symptoms of dementia can have harmful effects, including falling, confusion, dependence, and now - pneumonia.

In some cases, doctors prescribe benzodiazepines and related drugs known as Z-drugs to patients with dementia who wander, have sleep disturbances or show physical aggression. However, recent studies have raised concerns about prescribing these medications because of their association with falls that cause fractures, worsened cognitive function and dependence that can lead to withdrawal if they’re stopped. A new study published in the Canadian Medical Association Journal (CMAJ) found the drugs were associated with a slightly higher risk of severe pneumonia resulting in hospital admission or death.

Dr. Paula Rochon
Dr. Paula Rochon

Dr. Paula Rochon, vice-president of research at Women’s College Hospital, led a commentary on the new paper published in the same issue of CMAJ. “This finding is an example of a prescribing cascade, where a new drug therapy causes a new medical condition, leading to yet another drug therapy,” says Dr. Rochon, who developed the concept of the prescribing cascade.

Drug therapy in women and men

Z-drugs are associated with worse impairment of mental alertness in women than in men. For this reason, the U.S. Food and Drug Administration recommends lower doses of Z-drugs for women. Dr. Rochon’s commentary, co-authored with Drs. Nicholas Vozoris and Sudeep Gill, stresses that doctors must take these differences into account when they make prescribing decisions, and that we need more research in this area.

“If studies routinely explored the potential differences between older women and men in the development of adverse events, we would have the information that we need to prescribe therapies in a way that is tailored to women and men. Then we could improve outcomes for all older adults,” Dr. Rochon says.

Clinical recommendations

The commentary recommends that clinicians try non-pharmacological treatments before prescribing one of these drugs. Activities that keep older adults active and promote better sleep, reminiscence therapy, and reorienting dementia patients with items in their vicinity, such as a clock, a calendar or photos of their family, can help address the symptoms of dementia.

For those who are prescribed benzodiazepines or Z-drugs, the study reinforces the need for medication reviews. Some older adults are prescribed a drug therapy in hospital that they unintentionally continue after discharge. The commentary advises clinicians to be vigilant with medication reviews and avoid prescribing a new drug therapy for a symptom caused by the first, creating a prescribing cascade.

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