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

A Retrospective Cohort Study

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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.

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Acknowledgments

This study was funded by an Interdisciplinary Capacity Enhancement Grant (HOA-80075) from the Canadian Institutes of Health Research (CIHR) Institute of Gender and Health and the CIHR Institute of Aging, and by a Team Grant (OTG-88591) from the CIHR Institute of Nutrition, Metabolism and Diabetes. This study was conducted at the Institute for Clinical Evaluative Sciences (ICES), which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). No endorsement by ICES or the Ontario MOHLTC is intended or should be inferred.

Conflicts of interest and funding

Dr Herrmann has received research support and/or speaker’s honoraria from Lundbeck, Pfizer, Janssen-Ortho, Novartis, Sonexa and Sanofi-Aventis. None of the other authors had any potential conflicts of interest to disclose.

Author information

Authors and Affiliations

  1. Department of Psychiatry, Sunnybrook Health Sciences Centre, University of Toronto, 2075 Bayview Avenue, Toronto, ON, M4N 3M5, Canada

    Nathan Herrmann

  2. Toronto Western Hospital Movement Disorders Centre, University of Toronto and the Edmond J. Safra Program in Parkinson’s Research, Toronto, ON, Canada

    Connie Marras

  3. Institute for Clinical Evaluative Sciences, Toronto, ON, Canada

    Hadas D. Fischer, Xuesong Wang, Geoff M. Anderson & Paula A. Rochon

  4. Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada

    Geoff M. Anderson & Paula A. Rochon

  5. Women’s College Research Institute, Women’s College Hospital, Toronto, ON, Canada

    Geoff M. Anderson & Paula A. Rochon

  6. Department of Medicine, University of Toronto, Toronto, ON, Canada

    Paula A. Rochon

Authors
  1. Nathan Herrmann
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  2. Connie Marras
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  3. Hadas D. Fischer
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  4. Xuesong Wang
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  5. Geoff M. Anderson
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  6. Paula A. Rochon
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Corresponding author

Correspondence to Nathan Herrmann.

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Herrmann, N., Marras, C., Fischer, H.D. et al. Management of Neuropsychiatric Symptoms in Long-Term Care Residents with Parkinson’s Disease. Drugs Aging 30, 19–22 (2013). https://doi.org/10.1007/s40266-012-0038-8

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  • DOI: https://doi.org/10.1007/s40266-012-0038-8

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