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Parkinsonism in a nursing home: underrecognition
Joseph H Friedman1, Hubert H Fernandez, Martha M Trieschmann
1Division of Neurology, Memorial Hospital of Rhode Island, 111 Brewster St., Pawtucket, RI 02860, USA. joseph_friedman@mhri.org
Journal of Geriatric Psychiatry and Neurology
|March 17, 2004
Summary
Parkinsonism is frequently underdiagnosed in elderly patients, especially those with dementia. This study found significant rates of probable and possible parkinsonism in a nursing home population, with underrecognition in medical charts.
Area of Science:
- Geriatrics
- Neurology
- Clinical Pharmacology
Background:
- Parkinsonism is a common condition in the elderly, particularly those with dementia.
- Clinical experience suggests parkinsonism is often underdiagnosed in this population.
- Antipsychotic medications are known to increase the risk of drug-induced parkinsonism.
Purpose of the Study:
- To assess the prevalence of parkinsonian signs in nursing home residents.
- To compare clinical findings with chart documentation regarding diagnosis and medication use.
- To evaluate the recognition of parkinsonism, including drug-induced forms.
Main Methods:
- Blinded assessment of nursing home residents for parkinsonian signs using a standardized instrument.
- Chart review to identify medications (especially antipsychotics) and documented recognition of parkinsonism.
- Statistical comparison of parkinsonian features in residents on and off antipsychotics.
Main Results:
- Twenty-seven out of 100 residents had probable parkinsonism (12 severe), and 33 had possible parkinsonism.
- Among 27 residents on antipsychotics, 23 exhibited parkinsonian features, compared to 43 of 73 not on these drugs (P<.02).
- Parkinsonism was significantly underrecognized, with only 1 patient with drug-induced parkinsonism and 3 with diagnosed Parkinson's disease having documented recognition.
Conclusions:
- Parkinsonism is prevalent and often unrecognized in nursing home residents.
- Antipsychotic use is associated with a higher incidence of parkinsonian features in this population.
- Improved diagnostic awareness and documentation of parkinsonism are crucial in elderly care settings.