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However, we still did not find an association between benzodiazepine use and cognitive decline when we used methods to overcome this limitation by using the transformed CASI scores. People with heavy benzodiazepine use might have more frequent contact with the healthcare system, which could result in a higher likelihood of dementia being recognized and coded. Nonetheless, given the mixed evidence regarding benzodiazepines and risk of dementia and that these drugs are associated with many adverse events, healthcare providers are still advised to avoid benzodiazepines in older adults to prevent important adverse health outcomes, withdrawal, and dependence. Lastly, a further strength of this study is the covariate information collected directly from participants about characteristics that are not well measured in administrative data such as physical activity; universal and standardized assessment of depression. No additional data available. SLG affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned and, if relevant, registered have been explained. If these confounders lie in the causal pathway, this could result in overadjustment.

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All authors have completed the Unified Competing Interest form at www. The non-user group might include individuals with past benzodiazepine use who had experienced acute cognitive adverse events because of underlying preclinical dementia pathology and therefore did not have the opportunity to accumulate higher benzodiazepine use. Like other studies that have examined benzodiazepine use and risk of dementia, we are unable to rule out depletion of susceptible bias. All authors had full access to all of the data including statistical reports and tables in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Contrary to expectations, we found a small increased risk for dementia in people with low that is, up to one month or moderate one to four months use. Nonetheless, given the mixed evidence regarding benzodiazepines and risk of dementia and that these drugs are associated with many adverse events, healthcare providers are still advised to avoid benzodiazepines in older adults to prevent important adverse health outcomes, withdrawal, and dependence. We explored extending the lag period used to exclude prescriptions because of prodromal symptoms to more closely match the Canadian study and continued to find no association.

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A literature review of epidemiological studies. Late-life depression, mild cognitive impairment, and dementia. A corresponding limitation, however, is that no data on these characteristics are available before study enrollment, and in some cases covariates were therefore assessed after the start of exposure. It should be noted that our study did not examine the acute cognitive adverse events that can occur when treatment with a benzodiazepine is started in older adults and careful monitoring is recommended in this situation. Benzodiazepine and opioid use and the duration of intensive care unit delirium in an older population. We explored extending the lag period used to exclude prescriptions because of prodromal symptoms to more closely match the Canadian study and continued to find no association. Another methodological challenge is balancing the possible advantages of a new user design with the reality of how people use benzodiazepines that is, potentially episodic use over several decades and considerations of sample size. This pattern does not support a causal association between cumulative benzodiazepine use and risk of dementia, and the small increased risk observed with low use could represent treatment of prodromal symptoms, as supported by our sensitivity analyses.

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Another methodological challenge is balancing the possible advantages of a new user design with the reality of how people use benzodiazepines that is, potentially episodic use over several decades and considerations of sample size. The association between dementia and long-term use of benzodiazepine in the elderly: Ten-year trajectory of potentially inappropriate medications in very old women:

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