Behavioral effects of diazepam and propranolol in patients with panic disorder and agoraphobia

Effect of Antihypertensive Agents on Quality of Life in the Elderly

Management of hypertension in the elderly should take into account, in particular, the possible negative impact of antihypertensive drugs on the patient's quality of life, the deterioration of which may result in a loss of independence and reduced treatment compliance. Quality of life is recognised as a multifactorial variable and can be subdivided into different domains (symptomatic well-being, emotional, physical, work-social, cognitive and life satisfaction), which are generally explored by means of specific questionnaires or scales. When evaluating elderly patients with hypertension, it is necessary to pay particular attention to specific domains such as symptomatic well-being, cognitive function, activity and sexual function, which have already been diminished by the age itself and the disease. The results of some large trials that specifically evaluated the quality of life effects of long-term therapy of hypertension in older people (Medical Research Council's [MRC] Trial of Hypertension in Older Adults, Systolic Hypertension in the Elderly Program [SHEP], Systolic Hypertension in Europe [Syst-Eur], Study on COgnition and Prognosis in the Elderly [SCOPE]) have shown that antihypertensive treatment as a whole either had no negative impact on quality of life, or even produced some improvement. The question whether some classes of antihypertensive agents are more beneficial or harmful than others in terms of quality-of-life effects remains largely unanswered. Results from long-term trials suggest that treatment with diuretics is not associated with adverse effects on quality of life. Nevertheless, chlortalidone and other diuretics have been more often associated with sexual dysfunction in men, including decreased libido, erectile dysfunction and difficult ejaculation, than other drug classes. Nonselective lipophilic beta-adrenoceptor antagonists, such as propranolol, have been reported to exert some negative effect on quality of life and have been associated with depression, impairment of memory function and adverse effects such as erectile problems. A less unfavourable impact has been described with beta(1)-adrenoceptor antagonists and those with vasodilating properties. Calcium channel antagonists have generally been associated with a positive effect on quality of life, although some trials have shown high rates of adverse effects and withdrawals, particularly with first-generation dihydropyridines. Concern has also been raised about the potential for adverse cognitive effects associated with the use of calcium channel antagonists, but studies on this topic are not univocal. ACE inhibitors have usually been reported to exert favourable effects on quality of life. These drugs seem to be effective in maintaining, or even improving, cognitive function through mechanisms other than blood pressure control. In addition, a number of studies reported favourable impact of ACE inhibitors on sexual function. Angiotensin II receptor antagonists have been associated with good tolerability and low withdrawal rate. They have been demonstrated not to interfere with or even improve cognitive function as well as sexual performance. Although no class of antihypertensive agents presents a clearly superior effect over the others in terms of quality of life, the current impression is that ACE inhibitors and angiotensin II receptor antagonists may offer some advantage, at least in regard to effects on cognitive function and sexual activity.

Absence of neuropsychologic deficits in patients receiving long-term treatment with alprazolam-XR for panic disorder

Studies to date on the effects of benzodiazepines on neuropsychologic function have yielded conflicting data with respect to the type, severity, and duration of deficits that may be induced by these agents. As part of a placebo-controlled trial of alprazolam-XR (extended release) administered in combination with cognitive-behavioral therapy in patients with panic disorder, a battery of tests was used to measure neuropsychologic function. Thirty-eight outpatients were randomly assigned to receive either alprazolam-XR or placebo. Dosages were titrated up so that the alprazolam group (N = 18) received a mean dose of 4 mg/day (reduced in two patients because of sedative side effects). Neuropsychologic function after 6 weeks of therapy at the target dosage was compared with baseline assessments in each group. Both groups showed a statistically significant improvement from baseline to repeated assessments on measures of attention, executive functioning, psychomotor speed, and visual memory (p < 0.001); these gains were attributed to a practice effect. No significant changes were noted in measures of learning, verbal memory, or reaction time, and neither group showed any deterioration from baseline to retesting in any aspect of neuropsychologic function. These findings call into question the assumption that long-term benzodiazepine therapy produces significant neuropsychologic deficit in patients with diagnosed anxiety disorders.

Neuropsychological consequences of antihypertensive medication use

A growing proportion of the general population is being prescribed antihypertensive medications for the long-term treatment of essential hypertension. Untreated hypertensive individuals exhibit some neuropsychological performance decrements, and numerous researchers have sought to determine whether drug therapy for hypertension worsens, improves, or leaves unaltered objectively measured cognitive skills. These issues may be especially important in the elderly, among whom both high blood pressure and compromised cognitive function are common. In this review, we collate the findings of more than 50 clinical studies according to class of antihypertensive medication studied and domains of neuropsychological performance assessed. Special attention is given to investigations of elderly subjects, and a critical summary is provided.

Influence of cilazapril on memory functions and sleep behaviour in comparison with metoprolol and placebo in healthy subjects

1. In a controlled, randomized, double-blind study the influence of cilazapril and metoprolol on learning and memory functions and on sleep behaviour was investigated in healthy young volunteers under steady-state conditions. Twenty-three subjects were given either 2.5 mg cilazapril, 200 mg metoprolol, or placebo for 14 days in a latin square design separated by washout periods of 7 days. 2. To test memory functions different modalities--verbal, visual, numerical associative and two dimensional spatial memory were tested for recent anterograde recall, both short-term (less than 10 s) and middle-term (up to 15 min) were selected. The test had a content similar to that used in daily life situations. The sleep behaviour was tested both by objective (all night sleep EEG) and subjective measures. 3. Neither antihypertensive drug had an observable influence on memory performance at the dosages used under steady-state conditions. However, sleep was disturbed during metoprolol, while cilazapril could not be differentiated from placebo. The effects of metoprolol on sleep behaviour were observed in the objective and subjective measures. There was more frequent awakening during the night with the subjective complaint of difficulties in sleeping through. 4. From this study it is concluded that cilazapril has no major effect on memory functions and sleep behaviour. This is only true for the dosages given and under steady-state conditions.

Psychotropic effects of repeated doses of enalapril, propranolol and atenolol in normal subjects

1 Enalapril 20 mg, propranolol 160 mg, atenolol 50 mg and placebo each were given once a day for 8 days to 12 normal volunteers, using a Latin-square design and double-blind procedures. A battery of tests was applied before, 2 and 4 h after the dose on day 1 and 8. 2 EEG effects were detected on day 8 with propranolol but not consistently after atenolol or enalapril. 3 Reaction-time, symbol copying and memory were impaired with propranolol; only memory was marginally affected by atenolol. Enalapril impaired memory but improved tapping ability. 4 Subjectively, propranolol was associated with drowsiness, enalapril with calmness and perhaps contentedness. Ratings of headache were increased with enalapril. 5 It is concluded that the apparent beneficial subjective effects of enalapril in clinical practice are attributable partly to intrinsic central effects but mainly to the contrast with beta-adrenoceptor blockers such as propranolol.

The effect of anxiolytic drugs on memory in anxious subjects

The benzodiazepines (BZs), represented by diazepam, are the class of drugs used most frequently to treat clinical anxiety disorders. Since it is known that acute BZ intake impairs memory function, the effects of BZs on memory were evaluated in chronic users of BZ medications. In addition, the acute effects of diazepam were compared with those of the non-BZ anxiolytic buspirone on memory function in anxious subjects. Memory function was evaluated by a free verbal recall procedure where subjects recalled a list of 16 noncategorized nouns immediately after the word list was read (immediate recall) and again 20 min later (delayed recall). When the chronic BZ users were tested for free verbal recall during their first visit, 4-14 h after their last dose, they did not differ in immediate or delayed recall from an age- and sex-matched group of unmedicated anxious subjects. At a subsequent visit, the acute effects of BZ medications were studied 60-90 min after the subjects took their usual dose. Although acute BZ administration did not alter immediate recall, delayed recall was significantly impaired in the chronic BZ users. Thus, complete tolerance does not develop to the acute memory-impairing effects of BZs after long-term use. Acute administration of the anxiolytic drugs diazepam (5 mg) or buspirone (5 or 10 mg) did not alter immediate recall in another group of unmedicated anxious subjects. Diazepam selectively impaired delayed recall of the word list when compared with placebo. In contrast, neither dose of buspirone altered delayed recall. To the extent that such effects on verbal recall tests are reflected in a patient's daily activities, the failure of buspirone to adversely affect memory function could contribute to its usefulness as an alternative antianxiety therapy.

Effects of benzodiazepines on acquisition and performance: a critical assessment

Evidence related to the effects of benzodiazepines on learning and memory is reviewed in the contexts of human verbal learning studies and animal studies using both aversive and non-aversive paradigms. While the impairment of acquisition by benzodiazepines appears to be a robust phenomenon generalizing across species and experimental conditions, the impairment in the performance of an already-learned task by such drugs appears to be more restrictive and highly dependent upon experimental contingencies. Thus far, performance impairment appears to be found mainly in animal studies using non-aversive, food-motivated tasks, with such tasks being particularly well suited for investigating such a phenomenon. At present, there is a noticeable lack of knowledge regarding the neurochemical substrates underlying BDZ-induced impairment. Finally, some issues that may contribute to the presence or absence of a BDZ-induced performance impairment in published studies are briefly considered.