Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review
Background: Parkinsonism is a common side-effect of antipsychotic drugs especially in older adults, who also present with a higher frequency of neurodegenerative disorders like Idiopathic Parkinson’s disease (IPD). Distinguishing between antipsychotic-induced parkinsonism (AIP) and IPD is challengin...
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| Format: | Article |
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MDPI AG
2021-05-01
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| Series: | Medicines |
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| Online Access: | https://www.mdpi.com/2305-6320/8/6/24 |
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| author | Sharadha Wisidagama Abiram Selladurai Peter Wu Marco Isetta Jordi Serra-Mestres |
| author_facet | Sharadha Wisidagama Abiram Selladurai Peter Wu Marco Isetta Jordi Serra-Mestres |
| author_sort | Sharadha Wisidagama |
| collection | DOAJ |
| description | Background: Parkinsonism is a common side-effect of antipsychotic drugs especially in older adults, who also present with a higher frequency of neurodegenerative disorders like Idiopathic Parkinson’s disease (IPD). Distinguishing between antipsychotic-induced parkinsonism (AIP) and IPD is challenging due to clinical similarities. Up to 20% of older adults may suffer from persisting parkinsonism months after discontinuation of antipsychotics, suggesting underlying neurodegeneration. A review of the literature on AIP in older adults is presented, focusing on epidemiology, clinical aspects, and management. Methods: A literature search was undertaken on EMBASE, MEDLINE and PsycINFO, for articles on parkinsonism induced by antipsychotic drugs or other dopamine 2 receptor antagonists in subjects aged 65 or older. Results: AIP in older adults is the second most common cause of parkinsonism after IPD. Older age, female gender, exposure to high-potency first generation antipsychotics, and antipsychotic dosage are the main risk factors. The clinical presentation of AIP resembles that of IPD, but is more symmetrical, affects upper limbs more, and tends to have associated motor phenomena such as orofacial dyskinesias and akathisia. Presence of olfactory dysfunction in AIP suggests neurodegeneration. Imaging of striatal dopamine transporters is widely used in IPD diagnosis and could help to distinguish it from AIP. There is little evidence base for recommending pharmacological interventions for AIP, the best options being dose-reduction/withdrawal, or switching to a second-generation drug. Conclusions: AIP is a common occurrence in older adults and it is possible to differentiate it from IPD. Further research is needed into its pathophysiology and on its treatment. |
| first_indexed | 2024-03-10T11:02:53Z |
| format | Article |
| id | doaj.art-d6d5cfda6d2b4c7196cb21318eda6794 |
| institution | Directory Open Access Journal |
| issn | 2305-6320 |
| language | English |
| last_indexed | 2024-03-10T11:02:53Z |
| publishDate | 2021-05-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Medicines |
| spelling | doaj.art-d6d5cfda6d2b4c7196cb21318eda67942023-11-21T21:24:56ZengMDPI AGMedicines2305-63202021-05-01862410.3390/medicines8060024Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative ReviewSharadha Wisidagama0Abiram Selladurai1Peter Wu2Marco Isetta3Jordi Serra-Mestres4Departments of Psychiatry, Central and North West London NHS Foundation Trust, London NW1 3AX, UKDepartments of Psychiatry, Central and North West London NHS Foundation Trust, London NW1 3AX, UKDepartments of Psychiatry, Central and North West London NHS Foundation Trust, London NW1 3AX, UKKnowledge and Library Services, Central and North West London NHS Foundation Trust, London NW1 3AX, UKOld Age Psychiatry, Central and North West London NHS Foundation Trust, Uxbridge UB8 3NN, UKBackground: Parkinsonism is a common side-effect of antipsychotic drugs especially in older adults, who also present with a higher frequency of neurodegenerative disorders like Idiopathic Parkinson’s disease (IPD). Distinguishing between antipsychotic-induced parkinsonism (AIP) and IPD is challenging due to clinical similarities. Up to 20% of older adults may suffer from persisting parkinsonism months after discontinuation of antipsychotics, suggesting underlying neurodegeneration. A review of the literature on AIP in older adults is presented, focusing on epidemiology, clinical aspects, and management. Methods: A literature search was undertaken on EMBASE, MEDLINE and PsycINFO, for articles on parkinsonism induced by antipsychotic drugs or other dopamine 2 receptor antagonists in subjects aged 65 or older. Results: AIP in older adults is the second most common cause of parkinsonism after IPD. Older age, female gender, exposure to high-potency first generation antipsychotics, and antipsychotic dosage are the main risk factors. The clinical presentation of AIP resembles that of IPD, but is more symmetrical, affects upper limbs more, and tends to have associated motor phenomena such as orofacial dyskinesias and akathisia. Presence of olfactory dysfunction in AIP suggests neurodegeneration. Imaging of striatal dopamine transporters is widely used in IPD diagnosis and could help to distinguish it from AIP. There is little evidence base for recommending pharmacological interventions for AIP, the best options being dose-reduction/withdrawal, or switching to a second-generation drug. Conclusions: AIP is a common occurrence in older adults and it is possible to differentiate it from IPD. Further research is needed into its pathophysiology and on its treatment.https://www.mdpi.com/2305-6320/8/6/24parkinsonismantipsychotic drugsolder adults |
| spellingShingle | Sharadha Wisidagama Abiram Selladurai Peter Wu Marco Isetta Jordi Serra-Mestres Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review Medicines parkinsonism antipsychotic drugs older adults |
| title | Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review |
| title_full | Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review |
| title_fullStr | Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review |
| title_full_unstemmed | Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review |
| title_short | Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review |
| title_sort | recognition and management of antipsychotic induced parkinsonism in older adults a narrative review |
| topic | parkinsonism antipsychotic drugs older adults |
| url | https://www.mdpi.com/2305-6320/8/6/24 |
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