Current Methods for the Treatment and Prevention of Drug-Induced Parkinsonism and Tardive Dyskinesia in the Elderly

Abstract

Drug induced parkinsonism and tardive dyskinesia are iatrogenic consequences of the use of antidopaminergic drugs. Both entities share risk factors, physiopathological mechanisms and to some degree, therapeutic approaches. Here we review both entities and discuss emerging therapies including the recently approved drug deutetrabenazine and relevant aspects for clinical practice such as new diagnostic techniques. Key points:-Drug induced parkinsonism and tardive dyskinesia are iatrogenic consequences of the use of antidopaminergic drugs.-DIP is considered a direct consequence of the blockage of D2 receptors while TD has a more complex physiopathology, including enhanced sensitivity of dopamine receptors.-Both entities are more frequent in older people due to a progressive loss of dopaminergic neurons with age.-New therapies are available for TD, including deutetrabenazine. Compliance with ethical Standards:Disclosure of potential conflicts of interest: no funding was received for this study.The risks of drug-induced parkinsonism/tardive dyskinesia in the elderly and current methods to overcome it. 1.-IntroductionTardive dyskinesia (TD) and drug-induced parkinsonism (DIP) are iatrogenic disorders caused by dopamine receptor blockers (DRB) [1]. They were recognized early after the introduction of antipsychotics[2] to the clinical practice, leading to the finding that DIP caused by reserpine, a dopamine depleter, was related to dopamine deficiency [3].Elderly patients are more susceptible to these side effects, probably due to an age-related decrease in nigral neurons and dopamine [4]. Since the introduction of newer second generation antipsychotics (SGA) the frequency and intensity of these side effects has improved [5] , [6] , [7] , [8] but there is still room for concern [9], [10].TD and DIP share risk factors, pathological mechanisms and management, and might coexist in one given subject. Latest available evidence has clarified some intriguing features of TD and DIP. Meanwhile, new medications to treat TD are now available, highlighting the importance of a thorough, updated, knowledge of this pathologies.This article offers a comprehensive review of the incidence, clinical features and mechanisms behind DIP and TD. The benefits and risks of previous available drugs and those that have been recently approved by regulatory agencies are discussed. Drug induced Parkinsonism DefinitionDIP occurs when symptoms emerge after exposure to drugs, usually those that either deplete dopamine storages [11] or block dopamine receptors [12]. By definition, symptoms should be reversible, six months after the offending agent has been withdrawn[13] but actually up to 20% of patients develop persistent deficits despite drug discontinuation [14] leading to the hypothesis that these patients might have subclinical Parkinson's Disease (PD) unmasked by neuroleptic exposure (umPD), complicating the differential diagnosis [15], especially between aged patients, who are more prone to both PD and DIP. Epidemiology and risk factorsAfter PD, DI...

<p>Drug-Induced Movement Disorders and Its Associated Factors Among Patients Attending Treatment at Public Hospitals in Eastern Ethiopia</p>

“…This was consistent with other studies done. 19,32 The existence of primary movement disorders in the family especially in first degree relatives was also associated with pseudo-Parkinsonism (AOR= 2.43, 95% CI: 1.86, 6.17). It may be due to the hereditary transmission of Parkinsonism.…”

Amiodarone and Parkinsonism: a pharmacovigilance study

“…The first analysis compared parkinsonism reports in patients who received amiodarone (‘users’) versus unexposed ones (‘non‐users’). To assess the robustness of findings, we performed three sensitivity analyses: first, similar analysis according to sex [11]; second, similar analysis between 1/1/2000 and 31/12/2019; and third, after exclusion of drugs known to induce parkinsonism [7] (i.e., antipsychotics N05A according to the Anatomical Therapeutic Chemical classification, antivertigo drugs including cinnarizine and trimetazidine N07C, antiemetic and antinauseant drugs A04 and flunarizine N02C). Haloperidol was selected as positive control and morphine as negative one.…”

“…Papers reported cases of parkinsonism [2–6]. Amiodarone is sometimes listed among drugs inducing parkinsonism [7]. However, data came from case reports and doubt persists about the reality of the association.…”

Tardive Dyskinesia in Older Persons Taking Antipsychotics

“…39 The mechanism underlying agerelated increased susceptibility is unclear but may be due to higher cumulative exposure to APs as well as an age-related decrease in dopaminergic neurons in the substantia nigra. 40 Because APs are sometimes used off-label for dementia-related psychosis and aggression, 8,11 TD can be encountered in this population, particularly within facilities that care for older people. Up to 33% of patients residing in nursing homes or assisted living facilities receive APs, predominantly for off-label indications.…”