Drugs used to modify behavior in young or middle-aged adults may have serious consequences in later life.

Recent research has demonstrated that extended use of benzodiazepine drugs — commonly used for the management of anxiety and sleep dysfunction — increase the risk of developing Alzheimer's disease. The longer the drugs are in use for a patient, the greater the risk for developing Alzheimer's disease.

Medical providers specializing in the care of the elderly have recommended caution when prescribing these drugs for well over a decade. In 2011, the American Geriatrics Society, the leading organization providing education and guidance to primary care physicians regarding age-related health, teamed with the American Board of Internal Medicine Foundation to consider the top five treatment issues for those caring for elderly.

Among the five was the suggestion, "Don't use benzodiazepines or other sedative-hypnotics in older adults as first choice for insomnia, agitation or delirium. Large-scale studies consistently show that the risk of motor vehicle accidents, falls and hip fractures leading to hospitalization and death can more than double in older adults taking benzodiazepines and other sedative-hypnotics."

The benzodiazepines have wide application as anxiolytic, sedative, hypnotic, skeletal muscle relaxant, amnesic and anticonvulsants. The products are numerous and among them are: eszopiclone (Lunesta) diazepam (Valium), alprazolam (Xanax), zolpidem (Ambien) and lorazepam (Ativan).

A major concern with the Alzheimer's-type dementia associated with the benzodiazepines is that the pathology may not be reversible. Recent research authored by Ph.D. candidate Sophie Billioti de Gage of the University Bordeaux Segalen in France and several of her colleagues (DeGage 2014) looked at a large population data base of health records from patients in Quebec, Canada.

They studied the records of 1,796 patients diagnosed with Alzheimer's disease and 7,184 records of patients that had not been diagnosed with dementia, all over the age of 66. The study found indications that the negative impact starts as early as three months, and the effect is greatest in the longer-acting forms of the drugs.

The study found this link with benzodiazepines, and the association was explored as far back as six years prior to a diagnosis of Alzheimer's disease. The time period allowed for better control of causation bias as the prescription that far back was less likely initiated due to prodromal symptoms of Alzheimer's disease or its precursor, mild cognitive impairment.

The de Gage study published in the British Medical Journal is among numerous other published reports raising concerns about the risk of benzodiazepines and Alzheimer's disease. As early as 2002, Rajaa Lagnaoui from the University Victor in France reported an association. Even when controlling for age, gender, education, wine consumption, psychiatric history and depressive symptoms, the link to dementia was significant.

The findings reported in France have also been reported in other European countries as well as Asia. Chi-Shin Wu, M.D., from the Department of Psychiatry at Far Eastern Memorial Hospital in Taiwan investigated whether discontinuation of the drugs would result in a decreased risk.

The researchers found an association use with the diagnosis of dementia. However, the outcome with cessation of drug was more optimistic as the dementia risk was decreased, and the risk decrease was correlated with the length of time that the drug had been discontinued.

A major concern in the United States is the widespread use of benzodiazepines in older adults. Significant problems have been identified with the use of polypharmaceutical management of mental health problems among Veteran's Administration patients.

The widespread use of medications like benzodiazepines to manage behavioral problems, including post-traumatic stress disorder, was identified in VA care facilities. The combining of pharmaceutical therapies for PTSD has been demonstrated to result in significant numbers of adverse outcomes.

It is apparent that the benzodiazepine drugs have long-term consequences that warrant further study. Given their widespread use in the young and middle-age adult population, it is imperative that caution be exercised in prescribing the drugs until studies indicate they are not going to seriously impact the mental health of patients as they age.