Evidence Suggests Long-Term Cognitive Impact of Benzodiazepines

Forgetfulness, confusion, and delayed processing speed are often blamed on aging—but long-term use of benzodiazepines might be playing a bigger role than patients—or some prescribers— realize. Over 20% of long-term benzodiazepine users may experience cognitive impairment that affects memory, attention, and executive functioning.¹ As frontline medication experts, pharmacists are well-positioned to recognize these risks and guide appropriate deprescribing conversations.

Prescribers often relay on benzodiazepines to ease anxiety, seizures, or insomnia, but long-term use may come with a consequence: measurable cognitive impairment.¹ Evidence links these medications—especially when used beyond recommended durations—with changes in memory, executive function, and processing speed.

Data Indicates Cognitive Impairment With Sustained Benzodiazepine Use

In a 2022 study, researchers assessed patients with more than six months of continuous benzodiazepine use and found that 20.7% had clinically significant cognitive deficits. These impairments were not limited to the elderly; middle-aged adults were also affected. The most consistently impacted areas were verbal memory and psychomotor speed, although some domains improved slightly after discontinuation. Additional investigations have described a vast cognitive profile; sustained attention, episodic memory, and visuospatial processing are often impaired in chronic users.^1-3

Data from meta-analyses reinforce that long-term benzodiazepine users report significant impairment across multiple cognitive domains compared with controls, with moderate to large effect sizes. Following benzodiazepine withdrawal, many patients experience a partial recovery. However, persistent defects often remain, especially in working memory, processing speed, and divided attention. In some studies, these deficits have been observed up to 10 months post-benzodiazepine discontinuation.^3,4

These findings echo years of caution surrounding benzodiazepine prescriptions, which are often intended for short-term use—typically no longer than 2 to 4 weeks.⁵ However, real-world patterns show many patients continue them for months or even years, sometimes due to rebound symptoms or lack of tapering strategies.

Counseling Points for Pharmacists

For pharmacists, this raises critical opportunities for intervention. This includes performing medication reviews, checking for overlap with other CNS depressants, and initiating deprescribing conversations where appropriate.⁶ Patients may not notice subtle cognitive shifts, or they may dismiss them as being due to aging or stress.

Counseling points can be simple but proactive:

• Ask how patients are feeling cognitively, not just emotionally;
• Educate about alternatives (eg, selective serotonin reuptake inhibitors for anxiety or CBT for insomnia);
• Collaborate with prescribers on tapering plans when safe and appropriate; and
• Counsel patients about cognitive adverse effects.

It’s worth noting that not all long-term benzodiazepine users experience impairment, and some effects may be reversible. But with their unique expertise, pharmacists can effectively balance symptom control with long-term safety.

Ultimately, the goal isn’t to create alarm, but awareness. In a health care system where cognitive clarity is increasingly tied to quality of life, patients may benefit from more open, patient-centered discussions about potential cognitive adverse effects.

REFERENCES

1. Zetsen SPG, Schellekens AFA, Paling EP, Kan CC, Kessels RPC. Cognitive functioning in long-term benzodiazepine users. European Addiction Research. 2022;28(5):377-381. doi:10.1159/000525988

2. Neal D, Bressi J. Data show cognitive consequences of benzodiazepine use. Pharmacy Times. Published November 15, 2023. Accessed October 30, 2025. https://www.pharmacytimes.com/view/data-show-cognitive-consequences-of-benzodiazepine-use?utm_source=chatgpt.com

3. Zetsen SPG, Schellekens AFA, Paling EP, Kan CC, Kessels RPC. Cognitive functioning in long-term benzodiazepine users. Eur Addict Res. 2022;38(5):377-381. doi.org/10.1159/000525988

4. Barker MJ, Greenwood KM, Jackson M, Crowe SF. Cognitive effects of long-term benzodiazepine use: A meta-analysis. CNS Drugs. 2004;18(1):37-48. doi:10.2165/00023210-200418010-00004

5. Olfson M, Blanco C, Wang S, et al. Benzodiazepine use in the United States. JAMA Psychiatry. 2015;72(2):136-142. doi: 10.1001/jamapsychiatry.2014.1763

6. Ng BJ, Le Couteur DG, Hilmer SN. Deprescribing benzodiazepines in older patients: Impact of interventions targeting physicians, pharmacists, and patients. Drugs Aging. 2018;35(6):493-521. doi:10.1007/s40266-018-0544-4