Benzodiazepines, including well-known drugs like Valium and Xanax, are frequently prescribed to manage conditions like insomnia, anxiety, and seizures. They work by enhancing the body’s natural calming chemical, GABA. However, prolonged use can lead to long-term cognitive deficits — including an increased risk for dementia — especially in senior adults. Several alternatives, both medicinal and nonmedicinal, to this class of drug exist that can mitigate this risk.

Key Takeaways

Benzodiazepines act as sedatives in the central nervous system. Their usage, especially long-term, may lead to side effects such as memory issues, impaired coordination, and even addiction.
Concurrent use of benzodiazepines with other drugs or substances can result in severe side effects. Thorough discussions with health care providers about all current medications and supplements are critical before starting benzodiazepine treatment.
While some studies suggest a link between long-term use of benzodiazepines and increased dementia risk, the correlation is not definitive. It's important to monitor potential early signs of dementia, such as anxiety, depression, and sleep disturbances, in seniors prescribed these medications.
Despite potential risks, benzodiazepines can play a role in senior health under specific conditions. There are safer alternatives available, both medicinal and nonmedicinal, minimizing risks associated with benzodiazepine usage.

What are benzodiazepines and how do they impact senior brain health?

As family members, we naturally want to understand how the medications our senior loved ones take might affect their brain health, especially if we notice new or worsening memory or cognitive symptoms.

Benzodiazepines, including brands such as Xanax, Valium, Klonopin, and others, fall under a category of drugs that put the brakes on the brain’s communication with the body. If your loved one is in a state of overstimulation, these drugs serve to restore calm by producing a soothing, sedative effect. They manage this by working in the central nervous system, where they boost the impact of gamma amino-butyric acid (GABA) — the body’s chill-out chemical.^[01]

It’s worth noting there are various types of benzodiazepines, each differing in their potency, the conditions they treat, and the speed at which the body absorbs them.

This class of drug is often prescribed to tackle conditions such as:

Insomnia
Anxiety
Panic disorders
Seizures
Alcohol withdrawal symptoms

Side effects of benzodiazepines

Like all medications, benzodiazepines have their own set of side effects. These can vary among individuals, in terms of both duration and intensity.

Some of the common side effects include:

Drowsiness
Memory issues
Impaired coordination (particularly noticeable in seniors)
Dizziness and light-headedness
Confusion
Heightened anxiety
Blurred vision
Muscle weakness ^[02]

While short-term use of benzodiazepines can be both safe and effective, caution is warranted for long-term use. Regular use over an extended period may lead to:

Lasting cognitive deficits or memory loss
Coronary artery disease
Insomnia
Asthma or chronic obstructive pulmonary disease
Depression ^[03]

Furthermore, it’s important to be aware that long-term use can sometimes trigger physical dependency or even addiction, which can develop within just a few weeks. Stopping the use of benzodiazepines abruptly can prompt severe withdrawal symptoms.^[03] That’s why it’s recommended to discuss with your loved one’s doctor before changing or ending a benzodiazepine treatment.

If your senior loved one is on a regimen of benzodiazepines, assisting them with their medication schedule can be a useful approach to avoid misuse that could result in dependency. However, if you find that managing their medications is becoming too challenging, it might be time to consider senior living options. These facilities have experienced staff on hand who are well-versed in medication management, ensuring your loved one’s well-being and reducing the risk of benzodiazepine dependency.

Taking benzodiazepines alongside other drugs

Taking benzodiazepines with other prescribed or over-the-counter drugs can modify the drugs’ effects and potentially lead to dangerous interactions. Combining benzodiazepines with substances like alcohol, opioids, antidepressants, anticonvulsants, antipsychotics, and antihistamines can result in severe side effects such as breathing difficulties, overdose, or even death.^[01] Surprisingly, benzodiazepines might also interact with seemingly harmless substances like herbal supplements and grapefruit juice.^[04]

Ensure your loved one talks with their doctor or pharmacist before adding or discontinuing a medication while on benzodiazepines. It’s also very important to let their doctor know about all the current medications and supplements they are taking before initiating benzodiazepine treatment.

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The connection between benzodiazepines and dementia risks

Benzodiazepines and similar sedative-hypnotic drugs are known to affect memory function. In fact, a 2019 study published in Frontiers in Aging Neuroscience suggests there might be a direct connection between benzodiazepines and dementia risk. The relationship between benzodiazepines and dementia is further supported by a study in the British Medical Journal, which found a link between benzodiazepine use and an increased risk for Alzheimer’s disease. Finally, a 2019 meta-analysis published in the Journal of Clinical Neurology, which reviewed 10 separate studies, proposed that seniors who use benzodiazepines long-term have an increased dementia risk.

However, it’s important to remember that the relationship isn’t clearly established yet. While the studies above suggest that benzodiazepines may increase the risk of dementia, other studies indicate that seniors are prescribed these medications to manage symptoms like anxiety, insomnia, or depression, which might be early signs of undiagnosed dementia. This perspective comes from research published in the journal Current Opinion in Psychiatry.

The following symptoms could be early signs of dementia in your senior loved one:

Irritability
Anxiety
Depression
Apathy
Agitation
Sleep disturbances

Being aware of these early symptoms of dementia in your aging parents can give doctors valuable insights and lead to a more accurate diagnosis prior to benzodiazepine use.

The role of benzodiazepines in senior health

Benzodiazepine use among seniors is quite common and tends to be long term, despite the potential increased risk of dementia and other expert guidelines suggesting caution. The 2019 American Geriatrics Society Beers Criteria lists many types of benzodiazepines, including Xanax and Valium, as potentially not suitable for seniors due to the increased risks of:

Falls
Delirium
Fractures
Accelerated cognitive decline
Motor vehicle accidents

Seniors are particularly susceptible to the negative side effects from benzodiazepines. As we age, our bodies process medications differently, which can potentially cause harmful reactions. It’s important to note, though, that benzodiazepines aren’t all bad. The 2019 AGS Beers Criteria also indicates that these medications could be appropriate for seniors under specific conditions.

Some of these include:

Seizure disorders
Alcohol withdrawal
Certain severe sleep disorders

When it’s necessary to treat these conditions, doctors may prescribe benzodiazepines at low doses and for shorter time periods. This strategy can help minimize the side effects for seniors.

Exploring alternatives to benzodiazepines

For seniors, several safer alternatives to benzodiazepines exist, both in terms of medication and nonmedication approaches. These options typically have lower risks of dependence and misuse. If you’re worried about your loved one’s use of benzodiazepines and potential dementia risk, it might be time to talk with their doctor about other effective strategies for managing sleep issues or anxiety.

Options beyond benzodiazepines for sleep aids

When it comes to combating symptoms of insomnia in seniors, there are numerous choices. These include:

Cognitive behavioral therapy (CBT), a strategy for improving sleep habits by addressing the behaviors that contribute to insomnia
Low doses of doxepin, which can extend sleep duration and reduce night-time awakenings
Melatonin supplements, an over-the-counter product that could help speed up sleep onset
Low-caffeine green tea, known to relax the body and boost sleep quality
Ramelteon, an FDA-approved sleep aid for dealing with chronic insomnia
Valerian root, a plant that may have sedative features, although dosage and efficacy is yet to be determined
Probiotics, which are linked to positive effects on sleep quality
Cannabidiol (CBD), which can aid with insomnia and enhance sleep quality

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Alternatives to benzodiazepines for anxiety treatment

Numerous nonaddictive anxiety treatment options exist as alternatives to benzodiazepines, including the following:

Beta-blockers, a class of drugs effective for short-term anxiety relief
Antidepressants, often prescribed for managing both anxiety and depression
Low doses of antipsychotics can be useful for a variety of anxiety symptoms
Buspirone, a medication used for short-term treatment of anxiety symptoms
Monoamine oxidase inhibitors (MAOIs), which are typically used for treating anxiety when antidepressants aren’t effective
CBT, which can soothe nerves and transform patterns triggering anxious feelings ^[05]

Next steps for managing benzodiazepines and dementia

The global population of individuals living with Alzheimer’s or other forms of dementia is expected to surge to 139 million by 2050, according to the World Health Organization. Given the absence of any preventive treatment or cure, understanding the potential risks of benzodiazepines takes on a whole new level of importance.

If you’re noticing that your loved one may require additional care, or if managing their medications at home feels overwhelming, you’re not alone. A Senior Care Advisor can discuss your family’s unique needs, offering guidance about local senior living arrangements or home care options.

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References

Cleveland Clinic. (2023, January 1). Benzodiazepines (Benzos).
Bounds, C.G. & Nelson, V. L. (2023, January 7). Benzodiazepines.StatPearls.
Edinoff, A. N., Nix, C. A., Hollier, J., Sagrera, C. E., Delacroix, B. M., Abubakar, T., Cornett, E. M., Kaye, A. M., & Kaye, A. D. (2021). Benzodiazepines: uses, dangers, and clinical considerations. Neurology International.
U.S. Food and Drug Administration. (2021, July 1). Grapefruit juice and some drugs don’t mix.
Garakani, A., Murrough, J. W., Freire, R. C., Thom, R. P., Larkin, K., Buono, F. D., & Iosifescu, D. V. (2020, December 23). Pharmacotherapy of Anxiety Disorders: Current and Emerging Treatment Options. Frontiers in psychiatry.

Meet the Author

Amanda Lundberg

Amanda Lundberg, RN, has over 10 years’ experience in clinical settings, working extensively with seniors and focusing on wellness and preventative care.

Edited byKristin Carroll

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