Adult attention-deficit/hyperactivity disorder symptoms, cognitive dysfunction and quality of life in high-dose use of benzodiazepine and Z-drug

Angela Federico,Anna Bertoldi,Fabio Lugoboni,Stefano Tamburin,Elisa Mantovani,Rebecca Casari

doi:10.1007/s00702-020-02285-w

Abstract

High-dose use of benzodiazepines (BZDs) and Z-drugs was found to be associated with adult attention deficit/hyperactivity disorder (ADHD) and multidomain cognitive deficits, but the interplay between these factors and its effect on quality of life (QoL) is unclear. We explored (a) whether cognitive dysfunction differs in high-dose BZD/Z-drug users with and without adult ADHD and (b) the impact of cognitive deficits and adult ADHD on QoL in this substance-use disorder (SUD). From January 2015 to December 2019, we recruited 207 high-dose BZD/Z-drug users seeking treatment. We assessed the presence of adult ADHD with a screening tool, which was validated in SUD patients, and collected demographic, clinical and QoL data from the 76 included patients. A neuropsychological battery explored five cognitive domains. We found that: (a) screening for adult ADHD was frequently positive; (b) Short Form-36 (SF-36), a self-administered QoL questionnaire, was worse than the general population and worse in patients positive (ADHD+) vs. those negative (ADHD−) to ADHD screening tool; (c) executive function was significantly worse in ADHD+ than ADHD− patients; (d) some SF-36 dimensions were negatively influenced by executive dysfunction; (e) multivariate analysis showed an interplay between adult ADHD and cognitive dysfunction in worsening QoL. We documented a complex interplay between adult ADHD, cognitive dysfunction and QoL in high-dose BZD/Z-drug users. Assessing adult ADHD, neuropsychological measures and QoL may offer a full scenario of these patients, who are frequently impaired in everyday activities. Future research should explore whether pharmacological treatment might improve cognitive dysfunction and QoL in this SUD.

Highlights

Benzodiazepines (BZDs) and related Z-drugs are positive allosteric modulators of the gamma-amino-butyric acid type A receptor that are prescribed for the treatment of anxietyFabio Lugoboni and Stefano Tamburin have shared senior authorship.The estimated prevalence of long-term use of BZDs and Z-drugs at high doses ranges from 0.06 to 0.16% of the population in Europe (Ohayon and Lader 2002; Petitjean et al 2007)
The present study confirmed that (a) screening for adult Attention-deficit/hyperactivity disorder (ADHD) was frequently positive, (b) quality of life (QoL) (SF-36) was worse than the general population (Tamburin et al 2017b), and (c) worse in ADHD + than ADHD− patients (Lugoboni et al 2020b) in high-dose BZD/Z-drug users. This report yielded these new findings: (d) executive function was significantly worse in ADHD + than ADHD− patients, (e) some Short Form-36 (SF-36) dimensions were negatively influenced by executive function Z-score, and (f) multivariate analysis showed a complex interplay of adult ADHD and cognitive dysfunction in negatively influencing QoL measures (SF36 and General Health Questionnaire-12 (GHQ-12))
We provided new information on the interplay between adult ADHD, cognitive dysfunction and QoL in in highdose BZD/Z-drug users

Summary

Introduction

Benzodiazepines (BZDs) and related Z-drugs (i.e., zolpidem, zopiclone, eszopiclone, and zaleplon) are positive allosteric modulators of the gamma-amino-butyric acid type A receptor that are prescribed for the treatment of anxietyFabio Lugoboni and Stefano Tamburin have shared senior authorship.The estimated prevalence of long-term use of BZDs and Z-drugs at high doses ranges from 0.06 to 0.16% of the population in Europe (Ohayon and Lader 2002; Petitjean et al 2007). We have previously documented that high-dose BZD and Z-drug use (i.e., ≥ 5 times the recommended maximum daily dose; Liebrenz et al 2015) is associated with worse quality of life (QoL; Tamburin et al 2017b) and cognitive dysfunction involving multiple domains (Federico et al 2017). We have previously documented that a screening test for adult ADHD may be positive in approximately one-third of high-dose BZD and Z-drug users (Tamburin et al 2017c), and that adult ADHD is associated with worse QoL in this population (Lugoboni et al 2020b)

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