The incidence, morbidity, and risk factors for acute extrapyramidal syndromes (EPS) such as akathisia and drug-induced parkinsonism (DIP) in neuroleptic-treated elders have not been systematically explored. This study presents data on 17 elderly patients who were prospectively examined for up to 4 weeks for acute EPS, functional and cognitive status, and behavioral disturbances. Seventy-one percent of subjects developed DIP, and 18% developed akathisia. Predictors of DIP included pre-neuroleptic treatment parkinsonian signs and neuroleptic dose, despite use of low doses of neuroleptics. Development of acute EPS was associated with failure to improve behaviorally. New-onset urinary incontinence was the most common functional abnormality. (J Geriatr Psychiatry Neurol 1991;4:222-225).
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References
1.
Addonizio G. , Alexopoulos GS: Drug-induced dystonia in young and elderly patients. Am J Psychiatry1988 ;145:869-871.
2.
Swett C.: Drug-induced dystonia. Am J Psychiatry1975 ;132: 532-534.
Raskin DE: Antipsychotic medication and the elderly. J Clin Psychiatry1985;46:36-40.
5.
Aoba A., Kakita Y., Yamaguchi N., et al: Absence of age effect on plasma haloperidol neuroleptic levels in psychiatric patients. J Gerontol1985;40:303-308.
6.
Ayd FJ: A survey of drug-induced extrapyramidal reactions. JAMA1961;175:1054-1060.
7.
Ayd FJ: Early-onset neuroleptic-induced extrapyramidal reactions: A second survey, 1961-1981, in Coyle JT, Enna SJ (eds): Neuroleptics: Neurochemical, Behavioral and Clinical Perspectives. New York, Raven Press, 1983, pp 75-92.
8.
Jose C., Mallya A., Mehta D., et al: Iatrogenic morbidity in patients taking depot fluphenazine. Am J Psychiatry1979;136: 976-977.
9.
Moleman P., Janzen G., von Bargen BA, et al: Relationship between age and incidence of parkinsonism in psychiatric patients treated with haloperidol. Am J Psychiatry1986;143: 232-234.
10.
Devanand DP , Sackeim HA, Mayeux R.: Psychosis, behavioral disturbance, and the use of neuroleptics in dementia. Comp Psychiatry1988;29:387-401.
11.
Ambrosini PJ : A pharmacological paradigm for urinary incontinence and enuresis. J Clin Psychopharmacol1984;4:247-253.
12.
Peabody CA, Warner MD, Whiteford HA, Hollister LE: Neuroleptics and the elderly. J Am Geriatr Soc1987;35:233-238.
13.
Stephen PJ, Williamson J.: Drug-induced parkinsonism in the elderly. Lancet1984;2:1082-1083.
14.
Baldessarini RJ, Cohen BM, Teicher MH: Significance of neuroleptic dose and plasma level in the pharmacological treatment of psychoses. Arch Gen Psychiatry1988;45:79-91.
15.
Folstein MF , Folstein SE, McHugh PR: Mini-Mental State: A practical method for grading the cognitive state of patients for the clinician . Psychiatr Res1975;12:189-198.
16.
Gerlach J.: Tardive dyskinesia. Dan Med Bull1979 ;26:209-244.
17.
Lawton MP, Brody EM: The physical self maintenance scale. Gerontologist1969;9:179-186.
18.
Shader RI, Harmatz JS, Salzman C.: A new scale for clinical assessment in geriatric populations: Sandoz clinical assessment-geriatric (SCAG). J Am Geriatr Soc1974;22:107-113.
19.
Fleiss JL: Statistical Methods for Rates and Proportions. New York , Wiley Press, 1981.
20.
Baldessarini RJ: Chemotherapy in Psychiatry: Principles and Practice. Cambridge, Harvard University Press, 1985.
21.
Beasley Bal , Ford DH: Aging and the extrapyramidal system. Med Clin North Am1976;60:1315-1324.
22.
Cuhna UV: Differential diagnosis of gait disorders in the elderly. Geriatrics1988;43:33-42.
23.
Sabin TD: Biologic aspects of falls and mobility limitations in the elderly . J Am Geriatr Soc1982;30:51-58.
24.
Vissier H.: Gait and balance in senile dementia of Alzheimer's type. Age Ageing1983;12:296-301.
25.
Chui HC, Teng EL, Henderson VW, Moy AC: Clinical subtypes of dementia of the Alzheimer type. Neurology1985;35:1544-1550.
26.
Molsa PK, Marttila RJ, Rinne UK: Extrapyramidal signs in Alzheimer's disease. Neurology1984;34:1114-1116.
27.
Mayeux R., Stern Y., Spanton S.: Heterogeneity in dementia of the Alzheimer type: Evidence of subgroups . Neurology1985;35:453-461.
28.
Cummings JL, Frank DF: Dementia: A Clinical Approach. Boston, Butterworths, 1983.
29.
Hoffman WF, Labs SM, Casey DE: Neuroleptic-induced parkinsonism in older schizophrenics. Biol Psychiatry1987;22: 427-439.
30.
Gottlieb GL , McAllister TW, Gur RC: Depot neuroleptics in the treatment of behavioral disorders in patients with Alzheimer's disease . J Am Geriatr Soc1988;36:619-621.
31.
Devanand DP , Sackeim HA, Brown RP, Mayeux R.: A pilot study of haloperidol treatment of psychosis and behavioral disturbance in Alzheimer's disease. Arch Neurol1989;46:854-857.
Petrie WM, Ban TA, Berney S., et al: Loxapine in psychogeriatrics: A placebo and standard controlled clinical investigation. J Clin Psychopharmacol1982;2:122-126.
