A Case Report of Managing Cognitive Impairment in an Older Adult Patient Using Benzodiazepines and Antidepressants
Zh-Lin Li, I-Han Lee, Winston W. ShenAbstract
Background:
Benzodiazepines (BZDs) are commonly prescribed for treating insomnia in Taiwan. BZDs may cause reversible cognitive impairment such as amnesia, which can mimic dementia and complicate diagnosis.
Case Report:
We described an 84-year-old Taiwanese married female patient with major depressive disorder, generalized anxiety disorder, and severe cognitive impairment after received a two-year course of escitalopram, oxazepam, and brotizolam. Initially, she showed remarkable deficits in recent memory, similarity tests, and proverb interpretation. After a structured schedule of titrating mirtazapine and augmenting venlafaxine as well as deprescribing BZDs, her depressive symptoms and cognition were improved steadily. By day 29, her characteristic sense of humor returned, reflecting both symptomatic recovery and return of her normal self.
Conclusion:
This case highlights the importance of treating underlying diseases maximally to improve sleeping difficulties and deprescribe unneeded BZDs. Careful medication review and deprescribing BZDs can prevent misdiagnosis and ensure patient’s recovery.