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Benzodiazepine Risks in Dementia — MRCPsych Paper B MCQ

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ModerateOld Age PsychiatryBenzodiazepine Risks in DementiaMRCPsych Paper B

An 82-year-old woman with Alzheimer's disease has taken lorazepam 1 mg every night for 6 months for insomnia. She has become increasingly unsteady and intermittently more confused. Which adverse-effect profile is most characteristic of continued benzodiazepine treatment in this patient?

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Reveal the answer and explanation

Correct answer: A — Sedation or ataxia with falls, confusion or amnesia, paradoxical agitation, respiratory depression and dependence

Explanation lettering: B = shown as A · E = shown as B · D = shown as C · A = shown as D · C = shown as E

B is correct. Older people are more sensitive to benzodiazepines. Sedation, muscle weakness and ataxia increase falls risk, while confusion, impaired attention and anterograde amnesia may worsen apparent cognitive function in someone with dementia. Paradoxical reactions can include agitation, disinhibition or aggression and are more likely in older people. Continued use can produce tolerance and physical dependence, with withdrawal if treatment is stopped abruptly. Respiratory depression is a recognised risk, particularly with higher doses, respiratory disease, alcohol, opioids or other CNS depressants. Option A resembles adverse effects associated with SSRIs; C with acetylcholinesterase inhibitors; D with antipsychotics; and E describes an antimuscarinic adverse-effect profile.

Reference: Electronic Medicines Compendium. Lorazepam Aristo 1 mg orodispersible tablets, Summary of Product Characteristics, sections 4.4 and 4.8. Revised 2026. https://www.medicines.org.uk/emc/product/101894/smpc