***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: We examined the effects on sleep and memory of a nighttime dose of triazolam , 0.125 mg , in seven subjects with Alzheimer 's disease ( AD ) who were reported by caregivers to be frequently up at night . Subjects were admitted to an intermediate care hospital ward for the 8-day ABA design protocol ( placebo baseline-drug-placebo washout ) . Drug or placebo was given each evening at 2100 h. Sleep was assessed with a wrist-worn activity monitor . Memory was evaluated using a computerized delayed-matching-to- sample ( DMTS ) task administered at 0800 and 2130 h. Triazolam had no significant effects on total sleep time at night , latency to sleep onset , number of arousals , or time asleep during the day . DMTS performance was significantly worse at night compared to morning during baseline , but there were no significant drug effects . Our results suggest the st and ard geriatric dose of triazolam , 0.125 mg , may not be an effective hypnotic in AD patients with disrupted sleep , but neither does it substantially worsen the recent memory deficits of AD OBJECTIVES To determine if alprazolam is equally as effective as low dose haloperidol in managing disruptive behavioral episodes associated with delirium , dementia , and amnesic and other cognitive disorders ( formerly called organic mental syndromes ) . SETTING Twenty-five community nursing homes in western Washington . PARTICIPANTS Older nursing home residents ( N = 48 ) receiving a low-dose neuroleptic for the treatment of agitation and behavioral disturbances . INTERVENTION R and omized , double-blind , crossover trial of alprazolam and low dose haloperidol . Data were gathered at baseline and at the end of 6 and 12 weeks from direct observation and from clinical forms completed routinely by trained nurses . MEASUREMENTS Number of behavioral episodes , activities of daily living as measured by the Blessed Dementia Scale , extrapyramidal symptoms as measured by the Abnormal Involuntary Movement Scale ( AIMS ) , and psychopathology as measured by the Clinical Global Impressions ( CGI ) and the S and oz Clinical Assessment - Geriatric ( SCAG ) scales . RESULTS AND CONCLUSIONS No significant differences were observed between patients using haloperidol or alprazolam in terms of behavioral episodes per week . Further , with few exceptions , no significant differences were found in other outcome scales . Essentially the same findings were found when analyses were repeated for subgroups of patients with high levels of cognitive impairment and for patients with low and high levels of recorded problematic behavioral episodes . Alprazolam was as effective as low dose haloperidol in this population Fifty-nine elderly residents of long-term care facilities who had DSM-III diagnoses of dementia were studied in an 8-week r and omized , double-blind comparison trial of haloperidol , oxazepam , and diphenhydramine to test the efficacy of these agents in the treatment of clinical ly significant behavioral disturbances in patients with dementia . All three agents demonstrated modest but significant efficacy as measured by clinician ratings of agitated behavior and activities of daily living . The absolute magnitude of improvement was greater for haloperidol and diphenhydramine than for oxazepam , but differences among groups did not approach statistical significance . Frequencies of acute adverse events during the trial were similar across the drug treatment groups . Although these drugs may differ in terms of long-term safety and efficacy , they appear to be equivalent for short-term management of agitated behavior in severely demented patients This study was undertaken to compare the effects of 0.25 mg of brotizolam , 15 mg of flurazepam , and placebo on the sleep and performance of elderly subjects with chronic insomnia during a 2-week period of administration . Thirty-six male and female subjects who ranged in age from 60 - 72 years were divided into three treatment groups . All groups received placebo on the first three study nights , the active drug or placebo on the next 14 nights , and placebo again on the two following withdrawal nights . Sleep was assessed by means of question naires , and residual effects during the day were studied by means of the multiple sleep latency test and a variety of memory , performance , and vigilance tests . Sleep improved with all treatments . Rebound insomnia was noted on brotizolam withdrawal ; flurazepam withdrawal had a milder impact . At the end of this 19-night study , only the placebo-treated group was sleeping significantly longer than at baseline . Both drug treatments increased daytime sleepiness and impaired performance on the first day after their administration . These effects waned after 2 weeks of treatment with brotizolam , but not flurazepam . The results of this study affirm the increased sensitivity of elderly subjects to benzodiazepine hypnotics and their indication for acute or intermittent insomnia , rather than for the more chronic forms of this disorder BACKGROUND Benzodiazepines are extensively used in primary care , but their long-term use is associated with adverse health outcomes and dependence . AIMS To analyse the efficacy of two structured interventions in primary care to enable patients to discontinue long-term benzodiazepine use . METHOD A multicentre three-arm cluster r and omised controlled trial was conducted , with r and omisation at general practitioner level ( trial registration IS RCT N13024375 ) . A total of 532 patients taking benzodiazepines for at least 6 months participated . After all patients were included , general practitioners were r and omly allocated ( 1:1:1 ) to usual care , a structured intervention with follow-up visits ( SIF ) or a structured intervention with written instructions ( SIW ) . The primary end-point was the last month self-declared benzodiazepine discontinuation confirmed by prescription cl aims at 12 months . RESULTS At 12 months , 76 of 168 ( 45 % ) patients in the SIW group and 86 of 191 ( 45 % ) in the SIF group had discontinued benzodiazepine use compared with 26 of 173 ( 15 % ) in the control group . After adjusting by cluster , the relative risks for benzodiazepine discontinuation were 3.01 ( 95 % CI 2.03 - 4.46 , P<0.0001 ) in the SIW and 3.00 ( 95 % CI 2.04 - 4.40 , P<0.0001 ) in the SIF group . The most frequently reported withdrawal symptoms were insomnia , anxiety and irritability . CONCLUSIONS Both interventions led to significant reductions in long-term benzodiazepine use in patients without severe comorbidity . A structured intervention with a written individualised stepped-dose reduction is less time-consuming and as effective in primary care as a more complex intervention involving follow-up visits Objective To determine whether higher cumulative use of benzodiazepines is associated with a higher risk of dementia or more rapid cognitive decline . Design Prospect i ve population based cohort . Setting Integrated healthcare delivery system , Seattle , Washington . Participants 3434 participants aged ≥65 without dementia at study entry . There were two rounds of recruitment ( 1994 - 96 and 2000 - 03 ) followed by continuous enrollment beginning in 2004 . Main outcomes measures The  cognitive abilities screening instrument ( CASI ) was administered every two years to screen for dementia and was used to examine cognitive trajectory . Incident dementia and Alzheimer ’s disease were determined with st and ard diagnostic criteria . Benzodiazepine exposure was defined from computerized pharmacy data and consisted of the total st and ardized daily doses ( TSDDs ) dispensed over a 10 year period ( a rolling window that moved forward in time during follow-up ) . The most recent year was excluded because of possible use for prodromal symptoms . Multivariable Cox proportional hazard models were used to examine time varying use of benzodiazepine and dementia risk . Analyses of cognitive trajectory used linear regression models with generalized estimating equations . Results Over a mean follow-up of 7.3 years , 797 participants ( 23.2 % ) developed dementia , of whom 637 developed Alzheimer ’s disease . For dementia , the adjusted hazard ratios associated with cumulative benzodiazepine use compared with non-use were 1.25 ( 95 % confidence interval 1.03 to 1.51 ) for 1 - 30 TSDDs ; 1.31 ( 1.00 to 1.71 ) for 31 - 120 TSDDs ; and 1.07 ( 0.82 to 1.39 ) for ≥121 TSDDs . Results were similar for Alzheimer ’s disease . Higher benzodiazepine use was not associated with more rapid cognitive decline . Conclusion The risk of dementia is slightly higher in people with minimal exposure to benzodiazepines but not with the highest level of exposure . These results do not support a causal association between benzodiazepine use and dementia A r and omized , controlled , crossover clinical study compared 14-night treatment with 15 mg temazepam , 50 mg diphenhydramine , and placebo in elderly individuals with insomnia ( mean age , 73.9 years ; range , 70 - 89 years ) . Primary outcome measures were subjective assessment s of sleep recorded on sleep diaries . Secondary measures were the morning-after psychomotor impairment , using the digit symbol substitution task and the manual tracking task , and the morning-after memory impairment , using a free-recall procedure . Results showed sleep improvements with 15 mg temazepam compared with  placebo-sleep quality ( mean score , 3.3 ± 0.9 vs 2.9 ± 0.8 ; P = 0.03 ) , total sleep time ( 6.9 ± 1.0 hours vs 6.3 ±1.3 hours ; P = 0.02 ) , number of awakenings ( 1.5 ± 1.3 vs 2.0 ± 1.2 ; P < 0.001 ) , and sleep-onset latency ( 25 ± 22 minutes vs 37 ± 25 minutes ; P = 0.03 ) . Improvements were seen with diphenhydramine treatment compared with placebo on the number of awakenings only ( mean , 1.7 ± 1.1 vs 2.0 ± 1.2 ; P < 0.05 ) . Numbers of adverse events reported were similar after all treatments , although there was 1 fall during temazepam treatment . Findings indicate that temazepam is more effective  than diphenhydramine when compared with placebo at the doses tested , although this advantage is mitigated by the risk of falls associated with temazepam use . The choice of agent to use in the elderly must consider these relative benefits and risks The efficacy and safety of zolpidem , a hypnotic of a new chemical class ( the imidazopyridines ) , was compared with a reference benzodiazepine in elderly insomniac patients in a r and omized , double-blind , multicenter trial . Hospitalized patients aged 58 to 98 years were r and omized to receive zolpidem 5 mg ( 70 patients ) , zolpidem 10 mg ( 74 patients ) , or triazolam 0.25 mg ( 77 patients ) at bed-time . ( Three patients were excluded and 13 patients did not complete the study . ) The 3-week active treatment period was preceded by 3 and followed by 7 days of placebo administration . Sleep quality was assessed by the patient via a question naire and visual analog scale . A clinician 's global impression was also recorded . All measures of sleep quality were improved by both doses of zolpidem and by triazolam . The improvements between the end of the placebo phase and the end of the active treatment phase were significant for all treatments and assessment instruments . Moreover , the significant improvements in all measures were maintained during the week following withdrawal of both doses of zolpidem . The improvement in most sleep assessment parameters was maintained after withdrawal of triazolam .  Tolerability of all treatments was excellent . The majority of patients reported no adverse effects . The reported adverse effects in all groups included nightmares , daytime drowsiness , and day- or nighttime agitation . There was no evidence of rebound insomnia ; the therapeutic effect of zolpidem outlasted drug treatment . There were no signs of agitation or anxiety following cessation of treatment , which might be indicative of withdrawal phenomena . Confusion was recorded only in the triazolam group . These results suggest that zolpidem is at least as effective as triazolam in geriatric insomniac patients .  Zolpidem 5 mg and 10 mg demonstrated a good safety profile . On the basis of these data , zolpidem 5 mg should be given as a starting dose in elderly patients , with a possible increase up to 10 mg in more severe cases of insomnia The use of hypnotics in the elderly must be approached with special care in view of possible changes in pharmacokinetic behaviour and drug interactions in older patients . In a r and omized , double-blind study in a large geriatric department , midazolam was compared with the barbiturate combination Vesparax with regard to efficacy and safety . The comparison of the efficacy of the 2 hypnotics showed them to be almost identical in this respect . Side-effects , however , were more frequent with Vesparax . Furthermore , in the Vesparax group , unlike in the midazolam group , a troublesome cumulation of effect was observed , together with relatively frequent signs of hangover . It is concluded that , in appropriately titrated dosage , midazolam is an effective and well-tolerated hyp 
    Output:
    
Conclusion This systematic review suggests that BZD prescribing to older adults is significantly in excess of what the available evidence suggests is appropriate .