SAFETY AND EFFICIENCY OF ANTI-PARKINSON DRUGS FOR DLB/PDD PATIENTS

Abstract

One of the characteristic features of DLB (Dementia with Lewy Body) is high sensitivity to medicine, including not only neuroleptic drugs but also anti-parkinson drugs. Once hallucinations or systematized delusions were induced, it is too difficult to control psychiatric disorders as well as parkinsonism. The aim of this study is to decide the best anti-parkinson drug(s) for the treatment of parkinsonism with DLB and PDD (Parkinson’s disease with Dementia) patients. 28 patients diagnosed with DLB and 20 diagnosed with PDD were examined. Their histories of prescription medication and those of side effects were obtained retrospectively from medical records. [Results] Among 48 patients, 9 cases were not prescribed any anti-parkison drugs at all. Another 21 cases had some side effects, such as temporary hallucinations, delusions or nausea. Antiparkison medications causing frequent side effects included trihexyphenidyl (100%), amantazine (67%), istradefylline (63%), selegiline (50%) and dopamine agonists (33%). On the other hand, entacapone (10%), zonisamide (11%) and levodopa with carbidopa or benserazide (13%) seemed to be relatively safer for DLB/PDD patients. As to dopamine agonist, rotigotine (25%) showed lower rate of side effects than pramipexole (45%) and ropinirole (40%). In conclusion, for the treatment of parkinsonism in cases of DLB/PDD, levodopa/carbidopa or benserazide is the first choice, however, if more anti-parkinson therapy is necessary, the second candidate is zonisamide and/or entacapone from the viewpoint of safety.