The potential association between prolonged benzodiazepine use, including alprazolam (commonly known as Xanax), and an elevated risk of dementia has become a focus of scientific inquiry in recent years. Alprazolam, frequently prescribed for the management of anxiety and panic disorders, exerts sedative effects on the central nervous system. Nevertheless, concerns persist regarding its long-term impact on cognitive function, particularly among older populations. While some studies suggest a link between extended benzodiazepine use and cognitive decline, others highlight the inconclusive nature of the evidence, often confounded by factors such as pre-existing health conditions or polypharmacy. This review aims to critically analyze current research on the relationship between sustained Xanax use and dementia, examining potential underlying mechanisms, assessing the robustness of the available evidence, and identifying gaps in the existing body of knowledge. The objective is to provide a comprehensive understanding of whether Xanax use contributes to dementia risk and to guide healthcare professionals and patients regarding the cognitive implications of long-term benzodiazepine therapy.
Table of Contents
what is Xanax?
Alprazolam, a pharmacological agent classified within the benzodiazepine family, is widely utilized in the management of anxiety disorders and panic disorders, which are characterized by sudden episodes of intense fear and concern regarding recurrence. This medication functions by modulating the activity of gamma-aminobutyric acid (GABA), a key inhibitory neurotransmitter in the central nervous system, thereby reducing hyperactivity in the brain. By enhancing GABAergic transmission, alprazolam exerts anxiolytic and calming effects, aiding individuals in managing anxiety symptoms, mitigating panic attacks, and reducing physiological overactivity. Clinical administration of alprazolam should adhere strictly to the dosing regimen prescribed by a healthcare professional, as exceeding the recommended dosage may pose health risks.(1)
What is Xanax used for?
Alprazolam (Xanax®) is a benzodiazepine approved by the U.S. Food and Drug Administration (FDA) for the treatment of anxiety disorders, including generalized anxiety disorder, and panic disorder, with or without agoraphobia. It is believed that alprazolam exerts its therapeutic effects by enhancing the activity of specific neurotransmitters in the brain. While Xanax is officially approved for generalized anxiety disorder and panic disorder, healthcare providers may sometimes prescribe it off-label for other conditions, which refers to the use of a drug for purposes not officially approved by the FDA. Xanax is effective in alleviating excessive worry and anxious thoughts, but it is important to recognize that it is not a long-term solution for anxiety or overthinking. Due to its potential for dependence and withdrawal, Xanax is generally prescribed for short-term use only.(2)
Xanax addiction treatment
Alprazolam, commonly known as Xanax, presents significant challenges in the management of substance use disorders (SUD) due to the risks associated with benzodiazepine withdrawal. Xanax addiction risk increases, especially when taken in high doses or without proper medical supervision.
The optimal approach for discontinuing Xanax use is influenced by several factors, including the duration and dosage of use, the presence of any co-occurring medical conditions, and whether the individual is currently under the care of a healthcare provider, such as a psychiatrist.
A potential treatment for Xanax addiction involves a combination of behavioral therapy and medication-assisted support, ranging from less restrictive outpatient programs to more intensive inpatient detoxification in a hospital setting. The best treatment for Xanax addiction is determined by the individual’s specific medical needs and the goal of ensuring a safe discontinuation process. Various therapeutic interventions and combinations are employed to manage Xanax addiction.(4.5)
Xanax side effects
Alprazolam, marketed under the brand name Xanax, is a benzodiazepine commonly prescribed for the management of anxiety and panic disorders. While it may induce sensations of relaxation, calmness, or drowsiness, it is also associated with adverse effects such as dizziness, memory impairment, and xerostomia. Elderly individuals, in particular, are at an increased risk of experiencing more pronounced side effects, including significant sedation, dizziness, cognitive disturbances, and motor incoordination. Additionally, these patients may be more vulnerable to complications involving renal, hepatic, or pulmonary function. Such factors necessitate careful consideration and potential dosage adjustments when prescribing Xanax to older adults.(8)
Side effects of Xanax: read more about Xanax long term risks
Long-term Xanax and dementia have been linked. Does Xanax increase risk of dementia? Studies have suggested a potential link between long-term use of Xanax causing dementia-like cognitive decline in older adults, though further research is needed to establish causation. Chronic use of Xanax (alprazolam) can lead to significant adverse effects, including:
- Dependence
- Risk of overdose
- Cognitive decline
- Seizure activity
- Mental health disorders
- Impaired cognitive function
Research investigating the claim that “Xanax causes dementia” suggests a potential link between long-term benzodiazepine use and cognitive decline, though definitive causation remains unproven. Individuals who utilize benzodiazepines for a duration of less than three months do not exhibit a significant elevation in dementia risk, similar to those who never use these drugs. In contrast, users who consume benzodiazepines for a period of three to six months show a 32% heightened risk of developing Alzheimer’s disease, while those with usage exceeding six months face an 84% increased risk compared to non-users. The type of benzodiazepine employed also contributes to varying levels of risk; long-acting benzodiazepines, such as diazepam (Valium) and flurazepam (Dalmane), are associated with a greater likelihood of developing dementia compared to short-acting benzodiazepines, including triazolam (Halcion), lorazepam (Ativan), alprazolam (Xanax), and temazepam (Restoril).(6,4,9)
What is dementia?
Dementia refers to a decline in cognitive abilities, including memory, thinking, and reasoning, to the degree that it disrupts an individual’s ability to perform everyday tasks. Individuals with dementia may experience emotional dysregulation, and alterations in their personality can occur.
In Stage 1 of the Global Deterioration Scale (GDS), individuals exhibit no symptoms, and there is no observable cognitive decline. Although occasional memory lapses may occur, they do not significantly affect daily functioning. In the early stages of Alzheimer’s disease and other dementias, individuals typically experience alterations in cognitive functions such as memory, thinking, and reasoning, which progressively interfere with daily activities. As the disease advances, individuals may require increased assistance with basic tasks, such as bathing, grooming, and dressing. (3,2,9)
Those with frontal lobe dysfunction may display behaviors that are socially inappropriate or insensitive. Dementia also leads to changes in how individuals interact with their environment, with individuals suffering from Alzheimer’s disease often displaying forgetfulness and difficulty following conversations, which may lead to feelings of anger and frustration. Research indicates that the brain changes associated with Alzheimer’s, such as the accumulation of amyloid plaques and tau tangles, begin to develop at least a decade prior to the emergence of memory and cognitive issues. This pre-symptomatic phase, during which neural changes occur before clinical dementia symptoms manifest, is referred to as preclinical Alzheimer’s disease.
Different types of dementia
The most common are Alzheimer’s disease, vascular dementia, Lewy body dementia, frontotemporal dementia and mixed dementia.
Diagnosis dementia
A timely dementia diagnosis is crucial for implementing effective treatment plans and improving patient outcomes. There is no single diagnostic test for dementia. The diagnosis of dementia is based on a comprehensive evaluation, including a detailed medical history, physical examination, laboratory tests, and the assessment of cognitive, functional, and behavioral changes characteristic of each dementia type. A comprehensive dementia differential diagnosis is essential to distinguish between various neurodegenerative disorders and treatable conditions that may mimic cognitive decline.
While doctors can confidently diagnose dementia, identifying its specific type can be challenging due to overlapping symptoms and brain alterations across different dementias. In some instances, a diagnosis of “dementia” may be made without specifying the type, and further consultation with specialists such as neurologists, psychiatrists, psychologists, or geriatricians may be necessary.
The accuracy of an alcohol-related dementia diagnosis depends on a thorough assessment of the individual’s cognitive function and history of alcohol consumption. Alcohol-related dementia is a form of alcohol-related brain damage (ARBD) characterized by cognitive impairments resulting from chronic excessive alcohol consumption over an extended period. Individuals with alcohol-related dementia experience significant challenges in performing routine daily activities due to alcohol-induced brain damage. These impairments often include memory deficits and difficulties with reasoning and problem-solving.(11,15)
Dementia Treatment
The treatment approach for dementia is contingent upon its underlying cause. Although there is no cure for most progressive dementias, including Alzheimer’s disease, certain treatments — such as donanemab (Kisunala™) and lecanemab (Leqembi®) — have shown efficacy in reducing beta-amyloid, a hallmark protein of Alzheimer’s, thereby slowing cognitive and functional decline in individuals with early-stage Alzheimer’s. These treatments, along with other medications, can temporarily alleviate symptoms and enhance quality of life for individuals with Alzheimer’s and their caregivers. Additionally, non-pharmacological therapies may also provide symptom relief in various types of dementia.(20,25)
Benefits of early diagnosis dementia
Individuals diagnosed with dementia at an early stage can maintain meaningful and productive lives for extended periods. Early detection allows both the individual and caregivers to gain a better understanding of dementia, establish realistic expectations, and plan for the future collaboratively. Furthermore, an early diagnosis facilitates access to:
- Appropriate support to optimize quality of life, including treatments aimed at alleviating symptoms.
- Information that aids the individual and others in comprehending the cognitive and behavioral changes occurring.
- Entitlements to potential benefits or legal protections available to the individual.
List of drugs linked to dementia
Although a direct causal relationship has not been definitively established, memory impairment has been identified as a common adverse effect associated with several classes of medications. Consequently, the American Geriatrics Society, along with numerous studies, recommends caution in prescribing these drugs to older adults, whenever feasible. Drugs that can cause dementia:
- Anticholinergics
- Antidepressants
- Antipsychotics
- Benzodiazepines
- Antiepileptics
- Antihistamines
- Incontinence medications
- Sleep aids
- Antimuscarinics
- Chemotherapeutic agents
- Corticosteroids
- Diphenhydramine
- Antihypertensives
- Motion sickness treatments
- Analgesics
- Statins
Benzodiazepines, a commonly prescribed class of drugs for anxiety and insomnia in the elderly, have been associated with an increased risk of dementia. Research, including studies published in the Journal of Clinical Neurology, underscores the heightened dementia risk linked to the use of benzodiazepines, such as alprazolam (Xanax), chlordiazepoxide (Librium), clonazepam (Klonopin), and others. This risk is notably greater among individuals who use high doses of benzodiazepines over extended periods.(15,17,25,17)
Conclusion
The potential relationship between prolonged use of Xanax (alprazolam) and dementia continues to be an important focus of scientific investigation. While certain observational studies indicate a possible correlation between long-term benzodiazepine use and an elevated risk of dementia, these findings are influenced by confounding variables such as pre-existing medical conditions, the severity of anxiety or insomnia, and other comorbid health issues. Current evidence does not support a definitive causal link, underscoring the necessity for further longitudinal research and clinical trials to better understand this association. The objective of this review is to assess the existing body of research, identify knowledge gaps, and advocate for a cautious, evidence-based approach in the prescription of Xanax, particularly for extended use, to mitigate potential cognitive health risks. The aim is to encourage healthcare providers and patients to carefully consider the benefits and risks of prolonged Xanax use and explore alternative treatment options when appropriate.
Frequently Asked Questions
Frequently Asked Questions about Xanax and dementia:
What type of people are at risk of dementia?
It mainly affects older people but not all people will get it as they age.
Is Xanax addictive?
Xanax is highly addictive because the user’s anxiety can return after the drug wears off, and the calming effect ends.
Can alprazolam cause dementia?
To date, research has not conclusively established that Xanax or other benzodiazepines cause Alzheimer’s disease or other forms of dementia. However, these medications’ potential to affect cognitive function
Is Xanax a long term treatment for anxiety?
The Food and Drug Administration (FDA) has approved Xanax for very short-term treatment for most conditions.
How do you get a dementia diagnosis?
GP or another health professional thinks it’s possible you might have dementia, they will refer you to a local memory service, which has medical staff who specialize in dementia.
Can Xanax cause dementia?
Studies have suggested a potential link between the long-term use of Xanax and dementia risk, though further research is needed to confirm this association.
Can long term use of Xanax cause dementia?
To date, research has not conclusively established that Xanax or other benzodiazepines cause Alzheimer’s disease or other forms of dementia.
Does alprazolam cause dementia?
Research has shown that alprazolam and dementia may be linked, with concerns about the drug’s potential impact on cognitive function in individuals with Alzheimer’s disease or other forms of dementia.
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