Benzodiazepines: tolerability in elderly patients

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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