Hostname: page-component-848d4c4894-r5zm4 Total loading time: 0 Render date: 2024-07-01T12:29:37.855Z Has data issue: false hasContentIssue false
  • English
  • Français

Effets des benzodiazépines sur la performance cognitive et psychomotrice des personnes âgées souffrant d'insomnie

Published online by Cambridge University Press:  29 November 2010

Anouk M. Gagné  and
Charles M. Morin
Anouk M. Gagné
Affiliation:
Université Laval
Charles M. Morin
Affiliation:
Université Laval
Get access Rights & Permissions [Opens in a new window]

Abstract

This study investigates the effects of chronic use of benzodiazepines (BZ) as hypnotics on the neuropsychological performance of older adults with insomnia. Twenty-one older persons who had used BZ on a chronic basis (average duration = 21.7 years) for their sleep difficulties were enrolled in a medication withdrawal program. A neuropsychological evaluation was conducted before and after the taper program. A control group composed of older adults not using BZs and without sleep complaints were also evaluated for comparative purpose. The results showed that prolonged use of BZ produces mild and selective impairments of cognitive and psychomotor performance. However, BZ users subjectively evaluated their own performance much more negatively than good sleepers. The results are discussed in terms of a possible amplification of performance deficits among insomnia patients and also as a tolerance to adverse effects that develops with prolonged utilization of BZ.

Résumé

Cette étude évalue les effets de l'utilisation chronique de benzodiazépines (BZ) comme hypnotiques sur la performance de personnes âgées souffrant d'insomnie. Vingt et une personnes âgées utilisant des BZ depuis plusieurs années (durée moyenne d'utilisation = 21.7 ans) pour des difficultés de sommeil participent à un programme de sevrage de BZ. Une évaluation neuropsychologique est effectuée avant et après le sevrage. Un groupe contrôle composé de personnes âgées ne se plaignant pas de difficultés de sommeil et n'utilisant pas de BZ pour dormir est aussi évalué pour fins de comparaison. Les résultats indiquent que l'utilisation prolongée de BZ affecte la performance cognitive et psychomotrice, mais de façon plutôt limitée et sélective. Cependant, l'évaluation subjective que font les utilisateurs de BZ de leur performance est beaucoup plus négative que celle des non-utilisateurs et bons dormeurs. Les résultats sont discutés en fonction d'une amplification possible des déficits associés aux BZ chez les personnes souffrant d'insomnie et à une tolerance aux effets secondaires lors d'une utilisation prolongée de BZ.

Keywords

InsomniaBenzodiazepinesHypnoticsPerformance.Insomniebenzodiazépineshypnotiquesperformance.
Type
Articles
Information
Canadian Journal on Aging / La Revue canadienne du vieillissement , Volume 19 , Issue 4 , Hiver/Winter 2000 , pp. 479 - 493
Copyright
Copyright © Canadian Association on Gerontology 2000

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Références

American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders (4ie éd.). Washington, DC: Auteur.Google Scholar
American Sleep Disorders Association. (1990). International classification of sleep disorders: Diagnostic and coding manual. Rochester, MN: Auteur.Google Scholar
Beck, A.T., Epstein, N., Brown, G., & Steer, R. (1988). An inventory for measuring clinical anxiety: Psychometric properties. Journal of Consulting and Clinical Psychology, 56, 893–897.CrossRefGoogle ScholarPubMed
Beck, A.T., Ward, C.H., Mendelson, M., Mock, J., & Erbaugh, J. (1961). An inventory for measuring depression. Archives of General Psychiatry, 4, 561–571.CrossRefGoogle ScholarPubMed
Blais, F., Gendron, L., Mimeault, V., & Morin, C.M. (1997). Evaluation de l'insomnie: Validation de trois questionnaires. L'Encéphale, 23, 447–453.Google Scholar
Broman, J.E., Lundh, L.G., Aleman, K., & Hetta, J. (1992). Subjective and objective performance in patients with persistent insomnia. Scandinavian Journal of Behaviour Therapy, 21, 115–126.CrossRefGoogle Scholar
Carskadon, M.A., Seidel, W.F., Greenblatt, D.J., & Dement, W.C. (1982). Daytime carry-over of triazolam and flurazepam in elderly insomniacs. Sleep, 5, 361–371.CrossRefGoogle Scholar
Derogatis, L.R., & Melisaratos, N. (1983). The Brief Symptom Inventory: An introductory report. Psychological Medicine, 13, 595–605.CrossRefGoogle ScholarPubMed
Folstein, M.F., Folstein, S.E., & McHugh, P.R. (1975). “Mini-mental state.” A practical method for grading the cognitive state of patients for the clinician. Journal of Psychiatric Research, 12, 189–198.CrossRefGoogle ScholarPubMed
Ford, D.E., & Kamerow, D.B. (1989). Epidemiologic study of sleep disturbances and psychiatric disorders: An opportunity for prevention? Journal of the American Medical Association, 262, 1479–1484.CrossRefGoogle ScholarPubMed
Gallup Organization. (1991). Sleep in America. Princeton, NJ: Auteur.Google Scholar
Grant, D.A., & Berg, E.A. (1948). The Wisconsin Card Sorting Test: Systemic layout. Wisconsin: University of Wisconsin.Google Scholar
Greenblatt, D.J. (1992). Pharmacology of benzodiazepine hypnotics. Journal of Clinical Psychiatry, 53(suppl. 6), 7–13.Google ScholarPubMed
Hart, R.P., Morin, C.M., & Best, A.M. (1995). Neuropsychological performance in elderly insomnia patients. Aging and cognition, 2, 268–278.Google Scholar
Heaton, R.K., Chelune, G.J., Talley, J.L., Kay, G.G., & Curtiss, G., (1993). Wisconsin Card Sorting Test manual: Revised and expanded. Odessa, FL: Psychological Assessment Resources.Google Scholar
Hohagen, F., Kappler, C., Schramm, E., Rink, K., Weyerer, S., Riemann, D., & Berger, M. (1994). Prevalence of insomnia in elderly general practice attenders and the current treatment modalities. Acta Psychiatra Scandinavia, 90, 102–108.CrossRefGoogle ScholarPubMed
Johnson, L.C., & Chernik, D.A. (1982). Sedative hypnotics and human performance. Psychopharmacology, 76, 101–113.CrossRefGoogle ScholarPubMed
Kramer, M.D., Schoen, L.S., & Sharf, M. (1984). Effects of alprazolam on sleep and performance in geriatric insomniacs. Current Therapeutic Research, 35, 67–76.Google Scholar
Lezak, M.D. (1995). Neuropsychological Assessement (3rd ed.). New York: Oxford University Press.Google Scholar
Mamelack, M., Csima, A., Buck, L., & Price, V. (1989). A comparative study in the effects of brotizolam and flurazepam on sleep and performance in the elderly. Journal of Clinical Psychopharmacology, 9(4), 260–267.Google Scholar
Mellinger, G.D., Balter, M.B., & Uhlenhuth, E.H. (1985). Insomnia and its treatment: Prevalence and correlates. Archives of General Psychiatry, 42, 225–232.CrossRefGoogle ScholarPubMed
Mendelson, W.B., Garnett, D., Gillin, J.C., & Weingartner, H. (1984). The experience of insomnia and daytime and nighttime functioning. Psychiatry Research, 12, 235–250.CrossRefGoogle ScholarPubMed
Mendelson, W.B. (1995). Effect of flurazepam and zolpidem on the perception of sleep in insomniacs. Sleep, 18, 92–96.CrossRefGoogle ScholarPubMed
Mitler, M.M., Seidel, W.F., Van Den Hoed, J., Greenblat, D.J., & Dement, W.C. (1984). Comparative hypnotic effects of flurazepam, triazolam, and placebo: A long-term simultaneous nighttime and daytime study. Journal of Clinical Psychopharmacology, 4, 2–13.CrossRefGoogle ScholarPubMed
Monane, M. (1992). Insomnia in the elderly. Journal of Clinical Psychiatry, 53(suppl. 6), 19–22.Google ScholarPubMed
Morin, C.M. (1993). Insomnia: Psychological assessment and management. New York: Guilford Press.Google Scholar
Morin, C.M., Colecchi, C., Stone, J., Sood, R., & Brink, D. (1999). Behavioral and pharmacological therapies for late-life insomnia. Journal of the American Medical Association, 281, 991–999.CrossRefGoogle ScholarPubMed
Morin, C.M., & Wooten, V. (1996). Behavioral and pharmacological treatments for insomnia. Clinical Psychology Review, 16, 521–542.CrossRefGoogle Scholar
Reitan, R. (1958). Validity of the Trail Making Test as an indicator of organic brain damage. Perceptual and Motor Skills, 8, 271–276.CrossRefGoogle Scholar
Roth, T., & Roehrs, T.A. (1992). Issues in the use of benzodiazepine therapy. Journal of Clinical Psychiatry, 53(suppl. 6), 14–18.Google ScholarPubMed
Schneider-Helmert, D. (1987). Twenty-four hour sleep-wake function and personality patterns in chronic insomniacs and healthy controls. Sleep, 10,452–462.Google ScholarPubMed
Seidel, W.F., Ball, S., Cohen, S., Patterson, N., Yost, D., & Dement, W.C. (1984). Daytime alertness in relation to mood, performance, and nocturnal sleep in chronic insomniacs and noncomplaining sleepers. Sleep, 7, 230–258.CrossRefGoogle ScholarPubMed
Spinweber, C.L., & Johnson, L.C. (1982). Effects of triazolam (0.5 mg) on sleep, performance, memory, and arousal threshold. Psychopharmacology, 76, 5–12.CrossRefGoogle ScholarPubMed
Spreen, O., & Strauss, E. (1991). A compendium of neuropsychological tests: Administration, norms, and commentary. New York: Oxford University Press.Google Scholar
Stone, J., Morin, C.M., Hart, R.P., Remsberg, S., & Mercer, J. (1994). Neuropsychological functioning in older insomniacs with and without obstructive sleep apnea. Psychology and Aging, (2), 231–236.CrossRefGoogle Scholar
Tiffin, J. (1968). Purdue Pegbord Examiner's Manual. Rosemont, II: London House.Google Scholar
Walsh, J.K., & Engelhardt, C.L. (1992). Trends in the pharmacologic treatment of insomnia. Journal of Clinical Psychiatry, 53(12) (suppl.), 10–18.Google ScholarPubMed
Wechsler, D. (1981). WAIS-R manual. New York: The Psychological Corporation.Google Scholar
Wechsler, D. (1987). Wechsler memory scale-revised manual. San Antonio, TX: The Psychological Corporation.Google Scholar