Abstract
Scientific background: Many elderly and in particular dementia patients seem to be affected by extrapyramidal-motor (extrapyramidal) syndromes (EPMS). However, up to now, only few and sometimes greatly varying data concerning the prevalence of EPMS at older ages are available. Furthermore, only a few studies concerning the epidemiology of prescription of the pharmacotherapy of dementia patients exist in Germany. This study now analysed the occurrence of EPMS in dementia patients in two different care situations (nursing home and outpatient care) taking into consideration the medicinal therapy (psychotropic drugs, in particular antipsychotic drugs).Patients and methodology: 81 dementia patients (60 nursing home residents, 21 outpatients) participated in the study. Besides analysing co-morbid diseases and the medicinal therapy the type and severity of the dementia and the occurrence of EPMS was analysed. The instruments used were the Mini-Mental Status Examination (MMSE), the Clinical Dementia Rating (CDR) Scale, the Nurses" Observation Scale for Geriatric Patients (NOSGER II) and the St. Hans Rating Scale (SHRS) for Extrapyramidal Syndromes.Results: While almost half of the dementia patients (46%) were treated with conventional (typical) antipsychotic drugs (nursing home residents significantly more often, p < ,05), approximately 13% received the more modern atypical drugs. Anti-dementia drugs were administered very rarely (17% of the persons surveyed). In nursing home residents, who suffered from dementia more severely overall, the percentage of those treated with anti-dementia drugs was significantly lower and amounted to just below 7% (p < ,001). A high prevalence of EPMS was observed in the dementia patients surveyed, these movement disorders could be put on record in more than two thirds of the cases (mostly parkinsonism symptoms, no dystonia however). Noteworthy correlations were found between the EPMS and the severity level of the dementia (rs = -0.64 bzw. 0.64, p < ,001). Those between the EPMS and the typical antipsychotic drugs were lower in comparison (rs = 0.25, p < ,05). The correlations with the treatment with atypical antipsychotic drugs were not significant (rs = 0.10, p = ,346).Discussion/Conclusion: The data point to a high prevalence of EPMS in dementia patients. Even though the correlations between EPMS and the treatment with antipsychotic drugs were lower than these between EPMS and the severity level of the dementia in this survey group (In interpreting these results it has to be taken into consideration, however, that on the one hand the exposure to antipsychotic drugs could only be quantified imprecisely and the connections between EPMS and antipsychotic drugs possibly would have become clearer from more detailed data. On the other hand, the severity level of the dementia also indirectly reflects an exposure to neuroleptic drugs.), the data suggest to look critically at the medicinal treatment. A therapy which is not based on the existing guidelines and which is characterized by frequent use of typical antipsychotic drugs and only very seldom administration of anti-dementia drugs is observed, in particular in the area of nursing homes.
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