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Benzodiazepines: tolerability in elderly patients

  [ 37 votes ]   [ Discuss This Article ] • March 6, 1996

Aging is a physiological process that shares many behavioral,
biochemical and neuroendocrine phenomena with the
pathophysiological situation of unresolved stress, as well as
with a pharmacologically induced syndrome resulting from
chronic benzodiazepine (BZ) consumption. Behavioral findings
include symptoms such as drowsiness, ataxia, fatigue,
confusion, weakness, dizziness, vertigo, syncope, reversible
dementia, depression, impairment of intellectual, psychomotor
and sexual function, agitation, auditory and visual
hallucinations, paranoid ideation, panic, delirium,
depersonalization, sleepwalking, aggressivity, orthostatic
hypotension, and insomnia. Neuroendocrine findings include:
central depletion of noradrenaline (NA), dopamine, adrenaline
(AD), and serotonin (5-HT); reduction in the ratio of
circulating NA/AD as well as platelet 5-HT and increase of
AD, plasma free 5-HT and cortisol. These disturbances
together with the increased platelet aggregability observed
in the three groups are typical of unresolved-stress
situations. Immunological findings include significant
reduction of peripheral T lymphocytes (CD3, CD4, CD8) and the
CD4/CD8 ratio, CD16 and gamma-delta cells. On the other hand,
the three groups (elderly subjects, subjects faced with
unresolved stress, and BZ consumers) show increase of the CD57
lymphocyte subset as well as natural killer cytotoxicity.
Alterations of several biological markers have also been
found, specifically in the oral glucose tolerance test, the
intramuscular clonidine test, and the
supine/orthostasis/exercise test. From a clinical point of
view, the three groups appear to be more susceptible to the
appearance and progression of many acute and chronic diseases
(infectious and malignant diseases). As a result, chronic
consumption of BZs should be avoided in both the elderly and
subjects in unresolved-stress situations.

Lechin F, van der Dijs B, Benaim M

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