Benzodiazepine Use Disorder and Cognitive Impairment in Older Patients: A Six-Month-Follow-Up Study in an Outpatient Unit in Barcelona.

OBJECTIVE: Adverse health effects including cognitive impairment have been described in older adults with benzodiazepine misuse, although the literature about this issue is scarce. The present study aimed to assess cognitive decline in older adults with benzodiazepine use disorder and changes in cognitive state at the 6-month follow-up, as well as whether patients achieved abstinence. METHOD: A 6-month follow-up longitudinal study was conducted in an outpatient drug center in Barcelona in a sample of older adults (≥65 years old) who had benzodiazepine use disorder. The sample was compared with an equivalent control group. A neuropsychological protocol was performed at baseline and after 6-month follow-up covering the most important cognitive domains. RESULTS: The final sample comprised 33 patients with an average age of 73.5 years. At baseline, patients presented impairment in several domains compared with the control group: visual immediate recall (p < .001), visual delayed recall (p < .001), copy (p < .001), working memory (p < .003), immediate verbal learning (p < .002), total words learned (p < .009), set switching (p < .001), verbal fluency (p < .007), speed processing (p < .002), solving problems (p < .006), nonverbal fluency (p < .004), and sustained attention in all three areas omissions (p < .001), variability (p < .001), and perseverance (p < .005). At 6-month follow-up, patients achieving abstinence showed improvement compared with patients in active consumption in visual delayed recall (p < .006), total words learned (p < .010), and verbal fluency (p < .013). CONCLUSIONS: Benzodiazepine misuse in older adults may produce negative effects on cognitive skills. Recovery of some of these cognitive deficits may be possible with benzodiazepine abstinence.

Sex differences in an old adult sample with substance use disorder: A 6 months follow-up study.

Substance use disorder (SUD) is a worldwide concern that has its own particularities regarding age and sex. This study aims to assess the differences between old SUD women and men regarding socio-demographics, clinical factors and outcomes. A 6-months follow-up longitudinal study was conducted in an outpatient center, on a convenience sample of 115 SUD old adults (≥65 years old, average age of 71.57). Descriptive, bivariate, and multivariate analyses were performed. Data showed statistical significant differences between men and women related to sociodemographic variables (marital status, coexistence, criminal records and stress factors), medical and psychiatric conditions (women suffer higher rates of depression and anxiety, with worse health-related quality of life), family records (women had more presence of family psychiatric records) and SUD related parameters (men tend to use more alcohol, had an early onset, consume higher doses, report more craving and more tobacco life use while women had higher rates of prescription drugs use). At 6-month follow-up, the whole sample showed excellent rates of adherence and abstinence, without sex differences. The study points out sex differences on several sociodemographic and clinical variables, indicating their specific needs. This research could facilitate better approaches by considering a sex perspective in SUD old adults.

Alcohol use disorder and cognitive impairment in old age patients: A 6 months follow-up study in an outpatient unit in Barcelona.

There has been little research about deleterious effects, including cognitive impairment, related to hazardous long-term alcohol use in old adults. This study aims to assess cognitive decline in old patients with alcohol use disorder and changes in cognitive state at 6 months follow-up, achieving or not abstinence. A six-month follow-up study was conducted in an outpatient center in Barcelona on a sample of old adults (≥65 years old) who had hazardous alcohol use. The sample was compared with healthy volunteers adjusted for age, sex and years of education. A neuropsychological protocol was performed at baseline and after 6 months follow-up covering four cognitive domains: attention, visuospatial abilities, memory and executive functions. Several domains were significant impaired at baseline: visual immediate and delayed recall, working memory, immediate verbal learning, total words learned, set switching and sustained attention. At 6 months reassessment, alcohol abstinence was achieved in 93.5% of patients and it was detected a trend towards improvement in direct mean scores of all cognitive areas, although it was not significant. The current study points out a cognitive impairment in many areas secondary to alcohol long-term hazardous use in old adults. A trend towards cognitive improvement after recovery was detected in most patients.

Mirtazapina bucodispersable: un estudio comparativo de eficacia y tolerabilidad frente a la formulación convencional / Oral desintegrating mirtazapine tablets: comparison of efficacy and tolerability versus the conventional formulation

Fundamentos: La introducción en el mercado de las formulaciones bucodispersables de algunos psicofármacos trata de justificarse por un perfil de eficacia, tolerabilidad o facilidad de uso más favorable que el de las formulaciones convencionales de absorción intestinal. Objetivo: Comprobar si existen diferencias de eficacia y tolerabilidad entre las presentaciones convencional y bucodispersable de mirtazapina, el único antidepresivo disponible en ambas formulaciones. Material y método: Mediante un sistema protocolizado de registro, se recuperó de los historiales clínicos los datos demográficos y terapéuticos y se completaron diversas variables de eficacia y tolerabilidad de 268 pacientes tratados con mirtazapina convencional (48,3%) o bucodispersable (51,7%), en 3 centros asistenciales españoles, durante un período de 2 años (2003-2005). Se hizo la comparación mediante un análisis estadístico lineal simple, basado en diferencias de medias y porcentajes de las variables computadas. Resultados: En conjunto, se aprecian mejores resultados de eficacia y tolerabilidad con la presentación bucodispersable que con la convencional. Concretamente, se producen menos abandonos del tratamiento (el 10,8 y el 35,4%), menos efectos adversos (el 25,2 y el 44,6%) y mejores respuesta y tolerabilidad terapéuticas en general. Sin embargo, y pese a observarse un discreta tendencia favorable a la formulación bucodispersable en el cambio de peso entre el inicio y el final del tratamiento, no se alcanzó una diferencia estadísticamente significativa (2,3 kg con la formulación bucodispersable y 2,4 kg con la formulación convencional). Conclusiones: Pese a las limitaciones del estudio, de tipo naturalístico y retrospectivo, es posible aceptar que la formulación bucodispersable de mirtazapina presenta una mayor efectividad terapéutica general y un perfil de uso más favorable que la formulación convencional

Introduction: Orally disintegrating tablets of some psychotropic drugs have been introduced on to the market. These formulations are justified by their efficacy and tolerability profile and their ease of use in comparison with conventional, intestinally absorbed tablets. Objective: To verify whether efficacy and tolerability differs between conventional and orally disintegrating mirtazapine tablets, the only antidepressant available in both formulations. Material and Method: A protocolized system was used to register demographic, therapeutic, efficacy and tolerability variables from the clinical histories of 268 outpatients treated with conventional mirtazapine (48.3%) or orally disintegrating tablets (51.7%) in three Spanish mental health centers over a 2-year period (2003-2005). The variables were compared using a simple linear statistical analysis based on differences in the averages and percentages of the computed variables. Results: Better overall results on efficacy and tolerability were found in the orally disintegrating tablet formulation versus the conventional formulation. Specifically, there were fewer drop-outs (10.8% vs 35.4%), fewer adverse effects (25.2% vs 44.6%), and better overall therapeutic response and treatment tolerance. Weight gain between the beginning and end of treatment was slightly lower with orally disintegrating tablets, but this tendency was not statistically significant (2.3 kg for orally disintegrating tablets vs 2.4 kg for conventional tablets). Conclusions: Despite the limitations of this naturalistic and retrospective study, the results suggest that orally disintegrating mirtazapine tablets have better overall therapeutic efficacy and a more favorable tolerability profile than the conventional mirtazapine formulation