Abstract
BackgroundAlthough Idiopathic Parkinson’s disease (IPD) develops in considerable patients with drug-induced Parkinsonism (DIP), the association hasn’t been well defined. We aimed to evaluate the underlying association and risk factors of DIP and IPD.MethodsA retrospective cohort study using National Health Insurance Claims data in 2011–2016 was conducted. New-onset DIP patients in 2012 were selected and matched with active controls having diabetes mellitus at a 1:4 ratio by age, sex, and Charlson’s Comorbidity Index score. Comorbidity, causative drugs, and prescription days were evaluated as covariates.ResultsA total of 441 DIP were selected. During the 4-year follow up, 14 IPD events in the DM group but 62 events in the DIP group were observed (adjusted hazard ratio, HR: 18.88, 95% CI, 9.09–39.22, adjusting for comorbidities and causative drugs). IPD diagnosis in DIP was observed high in males compared to females (15.58/13.24%). The event was the most within the 1st year follow-up, mean days 453 (SD 413.36). Subgroup analysis in DIP showed calcium channel blocker (verapamil, diltiazem, and flunarizine) was significantly associated with increased IPD risk (HR: 2.24, 95% CI, 1.27–3.93).ConclusionIncreased IPD in DIP patients might not be from the causal toxicity of antidopaminergic effects but from a trigger by the causative drugs on the DIP patients who already had subclinical IPD pathology. DIP can serve as a strong proxy for IPD incidence. Subjects who develop DIP should be monitored carefully for potential IPD incidence.
Highlights
Drug-induced Parkinsonism (DIP) is the most serious iatrogenic movement disorder in the elderly as it increases the risk of gait dysfunction, falls, assisted living condition and considerably decreases the daily functioning and quality of life [1]
During the 4-year follow up, 14 Idiopathic Parkinson’s disease (IPD) events in the DM group but 62 events in the DIP group were observed
IPD diagnosis in DIP was observed high in males compared to females (15.58/13.24%)
Summary
Drug-induced Parkinsonism (DIP) is the most serious iatrogenic movement disorder in the elderly as it increases the risk of gait dysfunction, falls, assisted living condition and considerably decreases the daily functioning and quality of life [1]. A recent 2016 report from the Rochester Epidemiology Project reported that the incidence of both the Idiopathic Parkinson’s disease (IPD) and Parkinsonism were increased significantly over the 30 years. DIP was the most common type of Parkinsonism, accounting for 11 of 15 cases (73.3%) in the youngest age group (0–39 years) [1]. The risk factors for DIP include aging, female sex, anti-dopaminergic potency and length of causative drug use, pre-existing extrapyramidal signs, and familial or genetic predisposition [3]. Idiopathic Parkinson’s disease (IPD) develops in considerable patients with druginduced Parkinsonism (DIP), the association hasn’t been well defined. We aimed to evaluate the underlying association and risk factors of DIP and IPD
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