Can benzodiazepines cause cognitive deficits in an 18-year-old?

Benzodiazepines Cause Cognitive Deficits in 18-Year-Olds

Yes, benzodiazepines can cause cognitive deficits in 18-year-olds, with evidence showing impairments in multiple cognitive domains including memory, attention, and processing speed. 1, 2

Cognitive Effects of Benzodiazepines in Young Adults

• Benzodiazepines are associated with cognitive impairment across multiple domains, including visuospatial ability, speed of processing, and verbal learning 1
• Young adults (18-24 years) who use benzodiazepines show profound changes in cognitive function, particularly with high-dose or long-term use 2
• These cognitive effects may persist even after discontinuation of the medication, with patients not returning to levels of functioning that match benzodiazepine-free controls 1

Specific Cognitive Deficits

• Multifocal cognitive dysfunction has been documented in high-dose benzodiazepine users, affecting:
  • Verbal memory
  • Visuospatial memory
  • Working memory
  • Attention
  • Executive functions 2
• The severity of cognitive impairment correlates with the cumulative benzodiazepine dose 2
• These cognitive effects occur even in the absence of neurological or psychiatric comorbidities (except anxiety or depression) 2

Risks Beyond Cognitive Effects

• Benzodiazepines are associated with additional adverse effects that may impact quality of life:
  • Increased risk of falls and fractures 3
  • Risk of dependence and withdrawal 4, 5
  • Reduced mobility and decline of functional independence 3
  • Unsafe driving skills 3
  • Potential for addiction 3

Prescribing Patterns and Concerns

• Despite guidelines recommending only short-term use, nearly 30% of young users are prescribed benzodiazepines for longer than 6 months 6
• The prevalence of benzodiazepine dispensation among individuals aged 0-24 years increased by 22% between 2006 and 2013, with a 20% rise specifically in young adults 6
• 65% of benzodiazepine prescriptions for young people are initiated outside of psychiatric services, suggesting potential inappropriate prescribing 6

Recommendations for Use in Young Adults

• Current consensus guidelines advise use of benzodiazepines solely on a short-term basis 3
• The American Geriatrics Society Beers Criteria identifies benzodiazepines as high-risk medications due to their cognitive effects, though these guidelines are primarily focused on older adults 3
• For anxiety disorders in young people, non-benzodiazepine alternatives should be considered first-line, including:
  • Cognitive-behavioral therapy
  • Problem-solving therapy
  • Supportive psychotherapy
  • Antidepressants when pharmacotherapy is needed 3

Mitigation Strategies if Benzodiazepines Must Be Used

• Use the lowest effective dose for the shortest duration possible 3
• Avoid concurrent use with other CNS depressants and alcohol 3
• Monitor for cognitive effects, particularly with tasks requiring attention and memory 1
• Consider gradual tapering when discontinuing to minimize withdrawal effects 3, 5
• Educate patients about potential cognitive effects and risks 1

In conclusion, the evidence clearly indicates that benzodiazepines can cause cognitive deficits in 18-year-olds, particularly with prolonged or high-dose use. Healthcare providers should carefully weigh these risks against potential benefits and consider non-pharmacological or alternative pharmacological approaches when treating anxiety or sleep disorders in young adults.