The Intricate Interplay Between Dementia and Hypnotics

The connection between the use of hypnotics and dementia has sparked significant interest and controversy in the medical community. This perspective aims to provide a succinct overview of the current understanding of this intricate relationship. Some studies have indicated a potential association between long-term use of specific hypnotics, such as benzodiazepines and Z-drugs, and an increased risk of dementia [1,2]. Consequently, concerns have arisen regarding potential cognitive impairment associated with these medications [3]. However, findings pertaining to the dose-response relationship have been inconsistent, and the precise mechanism by which hypnotics may heighten dementia risk remains unclear. Proposed mechanisms include disruptions in sleep architecture, impaired memory consolidation, heightened susceptibility to falls and resultant brain trauma, and direct neurotoxic effects of certain medications [4]. Nevertheless, several factors warrant contemplation in this context. Firstly, publication bias should be considered, as researchers may have a propensity to publish positive findings, and the topic of hypnotics-induced dementia may be subject to such biases due to its sensational nature [5]. Secondly, although Taiwanese studies with large sample sizes are frequently cited in relation to hypnotics and dementia, caution is advised as these studies rely on medical insurance data and may have limitations [6]. Thirdly, meta-analyses showing positive results have encompassed heterogeneous subjects [7]. Moreover, while depression has been controlled in most positive studies, more than half of the studies did not control for anxiety [8]. Additionally, most studies have explored the The Intricate Interplay Between Dementia and Hypnotics