Abstract
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.
Highlights
Extrapyramidal symptoms are well-known side-effects of dopamine 2 receptor (D2R)antagonist drugs, which act on D2Rs in the striatum and mesocortex [1], and comprise a range of acute and tardive motor phenomena, from rigidity, tremor and bradykinesia, to dystonia, dyskinesias, and akathisia
[123I]FP-CIT Single-photon emission CT (SPECT) can help distinguish whether Drug-induced parkinsonism (DIP) is drug-induced or an exacerbation of subclinical Idiopathic Parkinson’s disease (IPD)
Smell deficits in DIP patients may be more associated with dopaminergic loss than drug-mediated dopamine receptor blockade
Summary
Extrapyramidal symptoms are well-known side-effects of dopamine 2 receptor (D2R)antagonist drugs, which act on D2Rs in the striatum and mesocortex [1], and comprise a range of acute and tardive motor phenomena, from rigidity, tremor and bradykinesia, to dystonia, dyskinesias, and akathisia. Most cases of DIP are associated with the use of FGAs (especially high-potency ones), and less frequently with second generation antipsychotics (SGAs). Older people are at a higher risk of emerging neurodegeneration which could compound the differential diagnosis of parkinsonism. In this sense, DIP might sometimes represent the “unmasking”. Parkinsonism is a common side-effect of antipsychotic drugs especially in older adults, who present with a higher frequency of neurodegenerative disorders like. Distinguishing between antipsychotic-induced parkinsonism (AIP) and IPD is challenging due to clinical similarities. 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. Female gender, exposure to high-potency first generation antipsychotics, and antipsychotic dosage are the main risk factors
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