Drugs & Aging

, Volume 30, Issue 1, pp 19–22 | Cite as

Management of Neuropsychiatric Symptoms in Long-Term Care Residents with Parkinson’s Disease

A Retrospective Cohort Study
  • Nathan Herrmann
  • Connie Marras
  • Hadas D. Fischer
  • Xuesong Wang
  • Geoff M. Anderson
  • Paula A. Rochon
Short Communication

Abstract

Background

The management of neuropsychiatric symptoms, including psychosis, in Parkinson’s Disease (PD) is complicated by the fact that treatment with antipsychotics can worsen the movement disorder, which may necessitate changes to antiparkinsonian medications.

Objectives

The objectives of this study were to determine what antipsychotics are prescribed to residents in long-term care with PD and document subsequent changes in levodopa dosage.

Methods

A retrospective cohort study using administrative health database information from Ontario, Canada, was conducted. PD diagnostic codes were obtained from the Ontario Health Insurance Plan (physician diagnostic codes) and the Canadian Institute of Health Information (hospitalization discharge diagnoses). The Ontario Drug Benefit database provided information on the use of antiparkinsonian medications and antipsychotics. Residents diagnosed with PD in long-term care were included if they were treated with stable doses of levodopa monotherapy and received a new prescription for an antipsychotic. The type of antipsychotic and the changes in levodopa dosage were determined.

Results

There were 479 residents who met inclusion criteria. The prescribed antipsychotics were quetiapine (n = 192; 40 %), risperidone (n = 185; 39 %) and olanzapine (n = 81; 17 %), and only 21 (4 %) received a prescription for a typical antipsychotic. The first levodopa dosage change was a dose reduction in 469 (98 %) patients, and a dose increase in ten (2 %) patients.

Conclusions

Many PD patients in long-term care are treated with potentially inappropriate antipsychotic medications. However, there is no evidence that this treatment results in a prescribing cascade that leads to inappropriate increases in levodopa dosage.

References

  1. 1.
    Olanow CW, Watts RL, Koller WC. An algorithm (decision tree) for the management of Parkinson’s disease (2001): treatment guidelines. Neurology. 2001;56:S1–88.PubMedCrossRefGoogle Scholar
  2. 2.
    Ferreri F, Agbokou C, Gauthier S. Recognition and management of neuropsychiatric complications in Parkinson’s disease. CMAJ. 2006;175:1545–52.PubMedGoogle Scholar
  3. 3.
    Papapetropoulos S, Mash DC. Psychotic symptoms in Parkinson’s disease: from description to etiology. J Neurol. 2005;252:753–64.PubMedCrossRefGoogle Scholar
  4. 4.
    Fenelon G, Mahieux F, Huon R, Ziegler M. Hallucinations in Parkinson’s disease: prevalence, phenomenology and risk factors. Brain. 2000;123(Pt 4):733–45.PubMedCrossRefGoogle Scholar
  5. 5.
    Weintraub D, Moberg PJ, Duda JE, et al. Effect of psychiatric and other nonmotor symptoms on disability in Parkinson’s disease. J Am Geriatr Soc. 2004;52:784–8.PubMedCrossRefGoogle Scholar
  6. 6.
    Aarsland D, Larsen JP, Tandberg E. Predictors of nursing home placement in Parkinson’s disease: a population-based, prospective study. J Am Geriatr Soc. 2000;48:938.PubMedGoogle Scholar
  7. 7.
    Miyasaki JM, Shannon K, Voon V, et al. Practice parameter: evaluation and treatment of depression, psychosis, and dementia in Parkinson disease (an evidence-based review): report of the Quality Standards Subcommittee of the American Academy of Neurology. Neurology. 2006;66:996–1002.PubMedCrossRefGoogle Scholar
  8. 8.
    Frieling H, Hillemacher T, Ziegenbein M, et al. Treating dopamimetic psychosis in Parkinson’s disease: structured review and meta-analysis. Eur Neuropsychopharmacol. 2007;17:165–71.PubMedCrossRefGoogle Scholar
  9. 9.
    Seppi K, Weintraub D, Coelho M, et al. The Movement Disorder Society evidence-based medicine review update: treatments for the non-motor symptoms of Parkinson’s disease. Mov Disord. 2011;26:S42–80.PubMedCrossRefGoogle Scholar
  10. 10.
    Weintraub D, Chen P, Ignacio RV, et al. Patterns and trends in antipsychotic prescribing for Parkinson disease psychosis. Arch Neurol. 2011;88:899–904.CrossRefGoogle Scholar
  11. 11.
    Wang M-T, Lian P-W, Yeh C-B, et al. Incidence, prescription patterns, and determinants of antipsychotic use in patients with Parkinson’s disease. Mov Disord. 2011;26:1663–9.PubMedCrossRefGoogle Scholar
  12. 12.
    Gruneir A, Anderson GM, Rochon PA, Bronskill S. Transitions in long-term care and potential implications for quality reporting in Ontario, Canada. J Am Med Dir Assoc. 2010;11:629–35.PubMedCrossRefGoogle Scholar
  13. 13.
    Group TFCPS. Clozapine in drug-induced psychosis in Parkinson’s disease. Lancet. 1999;353:2041–2.CrossRefGoogle Scholar
  14. 14.
    No authors listed. Low-dose clozapine for the treatment of drug-induced psychosis in Parkinson’s disease. The Parkinson Study Group. N Engl J Med. 1999;340:757–63.CrossRefGoogle Scholar
  15. 15.
    Kurlan R, Cummings J, Raman R, Thal L. Quetiapine for agitation or psychosis in patients with dementia and parkinsonism. Neurology. 2007;68:1356–63.PubMedCrossRefGoogle Scholar
  16. 16.
    Shotbolt P, Samuel M, Fox C, David AS. A randomized controlled trial of quetiapine for psychosis in Parkinson’s disease. Neuropsychiatr Dis Treat. 2009;5:327–32.PubMedCrossRefGoogle Scholar
  17. 17.
    Rochon PA, Stukel TA, Sykora K, et al. Atypical antipsychotics and parkinsonism. Arch Intern Med. 2005;165:1882–8.PubMedCrossRefGoogle Scholar
  18. 18.
    Aarsland D, Perry R, Larsen JP, et al. Neuroleptic sensitivity in Parkinson’s disease and parkinsonian dementias. J Clin Psychiatry. 2005;66:633–7.PubMedCrossRefGoogle Scholar
  19. 19.
    Herrmann N, Lanctot KL. Pharmacological management of neuropsychiatric symptoms of Alzheimer disease. Can J Psychiatry. 2007;52:630–46.PubMedGoogle Scholar
  20. 20.
    Marras C, Gruneir A, Wang X, et al. Antipsychotics and mortality in parkinsonism. Am Journal Geriatr Psychiatry. 2012;20:149–58.CrossRefGoogle Scholar
  21. 21.
    Burn D, Emre M, McKeith I, De Deyn PP, Aarsland D, Hsu C, Lane R. Effects of rivastigmine in patients with and without visual hallucinations in dementia associated with Parkinson’s disease. Mov Disord. 2006;21:1899–907.PubMedCrossRefGoogle Scholar
  22. 22.
    Emre M, Tsolaki M, Bonuccelli U, et al. Memantine for patients with Parkinson’s disease dementia or dementia with Lewy bodies: a randomised, double-blind, placebo-controlled trial. Lancet Neurol. 2010;9:969–77.PubMedCrossRefGoogle Scholar

Copyright information

© Springer International Publishing Switzerland 2012

Authors and Affiliations

  • Nathan Herrmann
    • 1
  • Connie Marras
    • 2
  • Hadas D. Fischer
    • 3
  • Xuesong Wang
    • 3
  • Geoff M. Anderson
    • 3
    • 4
    • 5
  • Paula A. Rochon
    • 3
    • 4
    • 5
    • 6
  1. 1.Department of Psychiatry, Sunnybrook Health Sciences CentreUniversity of TorontoTorontoCanada
  2. 2.Toronto Western Hospital Movement Disorders CentreUniversity of Toronto and the Edmond J. Safra Program in Parkinson’s ResearchTorontoCanada
  3. 3.Institute for Clinical Evaluative SciencesTorontoCanada
  4. 4.Institute of Health Policy, Management and EvaluationUniversity of TorontoTorontoCanada
  5. 5.Women’s College Research InstituteWomen’s College HospitalTorontoCanada
  6. 6.Department of MedicineUniversity of TorontoTorontoCanada

Personalised recommendations