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Acute extrapyramidal syndromes in neuroleptic-treated elders: a pilot study
L Ganzini1, R Heintz, W F Hoffman
1Psychiatry Service, Portland VAMC, OR 97207.
Journal of Geriatric Psychiatry and Neurology
|October 1, 1991
Summary
Elderly patients on neuroleptics frequently develop extrapyramidal syndromes (EPS), including drug-induced parkinsonism (DIP) and akathisia. These conditions are linked to pre-existing parkinsonian signs and neuroleptic dose, impacting behavioral improvement and causing functional decline.
Area of Science:
- Geriatric Medicine
- Neuropharmacology
- Clinical Psychiatry
Background:
- Acute extrapyramidal syndromes (EPS) like akathisia and drug-induced parkinsonism (DIP) are common side effects of neuroleptic medications.
- Systematic exploration of EPS incidence, morbidity, and risk factors in elderly patients receiving neuroleptics is lacking.
Purpose of the Study:
- To investigate the incidence, risk factors, and clinical impact of acute EPS in elderly patients treated with neuroleptics.
- To identify predictors of DIP and akathisia in this vulnerable population.
Main Methods:
- Prospective observational study involving 17 elderly patients.
- Patients were monitored for up to 4 weeks for acute EPS, functional status, cognitive function, and behavioral changes.
- Assessment included evaluation of pre-neuroleptic parkinsonian signs and neuroleptic dosage.
Main Results:
- High incidence of DIP (71%) and akathisia (18%) observed in the study cohort.
- Pre-neuroleptic parkinsonian signs and neuroleptic dose were significant predictors of DIP, even with low doses.
- Development of acute EPS correlated with a lack of behavioral improvement.
- New-onset urinary incontinence emerged as the most frequent functional abnormality associated with EPS.
Conclusions:
- Elderly patients treated with neuroleptics are at high risk for developing acute EPS, particularly DIP.
- Risk factors for DIP include baseline parkinsonian features and medication dosage.
- Acute EPS significantly impacts functional and behavioral outcomes in elderly patients, highlighting the need for careful monitoring and management.