Antipsychotic-Induced Movement Disorders in the Elderly
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Drugs & Aging 2000 Nov; 17 (5): 363-384 1170-229X/00/0011-0363/$20.00/0 © Adis International Limited. All rights reserved.
Antipsychotic-Induced Movement Disorders in the Elderly Epidemiology and Treatment Recommendations Michael P. Caligiuri,1,2 Dilip V. Jeste1,2 and Jonathan P. Lacro3 1 Department of Psychiatry, University of California, San Diego, California, USA 2 Psychiatry Services, San Diego Veterans Affairs Healthcare System, San Diego, California, USA 3 Pharmacy Services, San Diego Veterans Affairs Healthcare System, San Diego, California, USA
Contents Abstract . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 1. General Considerations . . . . . . . . . . . . . . . . . . . . . . . . . 2. Pharmacological Considerations in the Elderly . . . . . . . . . . . 2.1 Influence of Age on Pharmacokinetic Parameters . . . . . . 2.2 Influence of Age on Pharmacodynamic Parameters . . . . . 3. Classification of Antipsychotic-Induced Movement Disorders . . . 4. Acute Antipsychotic-Induced Movement Disorders . . . . . . . . . 4.1. Dystonia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.2 Akathisia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 4.3 Parkinsonism . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5. Potentially Persistent Antipsychotic-Induced Movement Disorders 5.1 Tardive Dyskinesia . . . . . . . . . . . . . . . . . . . . . . . . . . 5.2 Other Tardive Syndromes . . . . . . . . . . . . . . . . . . . . . 6. Conclusion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Abstract
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We reviewed the epidemiological aspects of antipsychotic-induced movement disorders as they pertain to older patients. The incidence and prevalence of druginduced parkinsonism and tardive dyskinesia (TD) are significantly greater in the older patient than in the younger patient whereas akathisia seems to occur evenly across the age spectrum and dystonia is uncommon among older patients. The literature on risk factors associated with treatment-emergent movement disorders is highly variable. Treatment practices vary across the age range and the interaction between age and antipsychotic dosage confounds our understanding of the relative importance of treatment-related risk factors. However, there is general agreement that pre-existing extrapyramidal signs (EPS) increase the vulnerability of the patient to developing significant drug-induced movement disorders. Elderly patients with dementia are at gre
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