Drug induced parkinsonism: a common cause of parkinsonism in older people

Abstract

Drug induced parkinsonism is the second most common cause of parkinsonism in older people after idiopathic Parkinson's disease (PD). Risk factors for developing drug induced parkinsonism include: older age; female gender; dose and duration of treatment; type of agent used; cognitive impairment; acquired immunodeficiency syndrome (AIDS); tardive dyskinesia; and pre-existing extrapyramidal disorder. In most patients parkinsonism is reversible upon stopping the offending drug, though it may take several months to resolve fully and in some patients it may even persist. In this case, one needs to consider the possibility of PD which has been unmasked by the offending drug, and treatment with dopaminergic agents may be warranted. Drug induced parkinsonism adversely affects the quality of life in older patients and is potentially reversible, highlighting the importance of early recognition of this condition. This article discusses the drugs implicated, as well as the epidemiology, pathophysiology, clinical features, and management of drug induced parkinsonism.

Dépendance et syndromes Parkinsoniens en gériatrie

“…De plus, ces patients auraient plus de troubles posturaux [25] dont on sait qu'ils sont corrélés à une atteinte fonctionnelle plus marquée [9], une progression plus rapide de la maladie [12], et un risque de décès plus important [6]. Pour certains auteurs la iatrogénie représenterait la 2ème cause de SP après la MPI en gériatrie [3,5,[26][27][28], soit environ 20% des étiologies de SP [29]. Si de nombreuses thérapeutiques peuvent être en cause, comme certains inhibiteurs calciques, le valproate de sodium, ou les sérotononergiques, 2/3 des cas sont imputables aux neuroleptiques, y compris ceux dits « cachés » comme la métoclopramide (Primpéran®) [27].…”

“…Or la prescription de neuroleptiques est fréquente chez le sujet âgé [28] puisqu'on estime qu'entre 21% et 25% des patients de plus de 65 ans en EHPAD sont sous neuroleptiques, dont 1/3 qui sont atteints de SP [29][30]. La sévérité du phénotype clinique dépend de la dose, la durée et du type de neuroleptique [26,[28][29]. Il s'agit le plus souvent d'une atteinte symétrique, surtout bradykinétique associée à un tremblement d'action et d'attitude [29,31].…”

Prevalence of Extrapyramidal Side Effects in Patients on Antipsychotics Drugs at a Tertiary Care Center5

“…Akathisia occurs in 10% to 20% of patients treated with atypical antipsychotics, which is less than 20% to 52% with typical antipsychotics [21]. Akathisia may persist for the duration of antipsychotic therapy and usually ceases after the discontinuation of antipsychotics [22].…”

Drug-induced parkinsonism: diagnosis and management

“…Its causative mechanisms and clinical similarity with Lewy-body Parkinson's disease (PD) have contributed to our understanding of the latter condition and to the discovery of oral levodopa as symptomatic replacement therapy. 1 Although its prevalence is in part related to the aging of the population and expanded polypharmacy, [2][3][4] an individual variation in susceptibility has long been documented.…”

“…Miscellaneous nonneuroleptic drugs have been associated with a low risk of DIP: antiarrhythmics (amiodarone, procaine), acetylcholinesterase inhibitors, antibacterial (rifampicin), antiviral (acyclovir, vidarabine, antiretrovirals), and antifungal (amphotericin B) antibiotics, and hormones (thyroxine). 1,2,16 The thiazolidinedione derivative pioglitazone, a peroxisome proliferator-activated receptor-gamma and -alpha receptor agonist, has been reported to negatively have an impact on the motor benefit derived from levodopa in a primate model of parkinsonism, 53 but no report of DIP or aggravation of motor symptoms in PD subjects under oral hypoglycemic agents has been published. Anticancer agents generally do not interact with dopamine receptors.…”