Dementia risk is slightly elevated in patients with minimal exposure to benzodiazepines, according to research published in BMJ.

In a population-based prospective cohort study, researchers measured outcomes in 3,434 participants aged 65 years or older who did not have dementia at the time of enrollment. Subjects were recruited between 1994 and 1996 and 2000 and 2003, with continuous open enrollment beginning in 2004.

On a biennial basis, the researchers administered the cognitive abilities screening instrument (CASI) to screen for dementia, as well as to examine participants’ cognitive trajectory.

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“The average CASI score at baseline was 93.4, with similar scores across levels of cumulative benzodiazepine use (range 93.0-93.6),” wrote lead author Shelly L. Gray, PharmD, of the School of Pharmacy, University of Washington in Seattle, and colleagues. “We found no significant differences for any benzodiazepine use group in mean CASI or rates of decline compared with non-users.”

At follow-up, the investigators found that 797 participants (23.2%) developed dementia. Of that group, 637 (79.9%) developed Alzheimer’s disease. The researchers did not find an association between the highest level of benzodiazepine use (≥121 total standard daily doses [TSDDs]) for dementia (hazard ratio [HR], 1.07) or Alzheimer’s disease (HR, 0.95) when compared with non-use.

“There was a slightly increased risk for dementia for participants with low (1-30 TSDDs; HR, 1.25) or moderate use (31-120 TSDDs; HR, 1.31),” said Dr. Gray. No increased risk in those with the highest exposure levels was identified. However, Dr. Gray and colleagues suggest that, “given the mixed evidence regarding benzodiazepines and a risk of dementia and that these drugs are associated with many adverse events, healthcare providers are still advised to avoid benzodiazepines in older adults.”


  1. Gray SL, Dublin S, Yu O, et al. Benzodiazepine use and risk of incident dementia or cognitive decline: prospective population based study. BMJ. 2016;352. doi: 10.1136/bmj.i90