Comparing Midazolam and Dexmedetomidine in Treatment for Dementia

In a study in Scientific Reports, researchers compared the effects of intravenous sedation with either midazolam (MID) or dexmedetomidine (DEX) on the cerebral function of elderly patients undergoing treatment for dementia. According to the study’s first author, Yoshinari Morimoto, intravenous sedation to an Observer’s Assessment of Alertness/Sedation (OAA/S) score of two decreased cerebral blood flow (CBF) by up to 11% with MID, whereas CBF was stable with DEX. Additionally, MID sedation exhibited significantly lower CBF (–5%) right when an OAA/S score of two was reached compared to DEX sedation (±0%).

Comparing Sedation Agents In Treatment for Dementia

This randomized cross-over study included 12 elderly patients—11 with Alzheimer’s-type and one with Lewy body dementia—all of which were receiving a drug treatment for dementia. Investigators utilized bispectral index (BIS) and normalized tissue hemoglobin index (nTHI) to assess CBF.

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According to the authors, right nTHI 2 and nTHI 3 values significantly decreased by 5% and 11% compared to right nTHI 1 (p = 0.001) in the MID sedation group. Likewise, the MID group had a decrease of 6% from baseline in both left nTHI 2 and nTHI 3. Conversely, both nTHI measurements on both sides in the DEX group were at the baseline value of one, and “no significant change was observed,” wrote the investigators.

Conclusions

Further noting that the decrease in BIS values was comparable between the groups, the authors ultimately concluded that, “from the perspective of maintaining CBF, DEX might be a safer option for intravenous sedation in elderly patients with severe dementia.”

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