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Early Detection of Neuroleptic-Induced Parkinsonism in Elderly Patients with Dementia

Departments of Psychiatry (Drs. Sweet, Rosen, Mulsant, Pollock, Perel, and Ms. Altieri) and Pharmacology (Drs. Pollock and Perel), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Bruce G. Pollock, MD, PhD

Departments of Psychiatry (Drs. Sweet, Rosen, Mulsant, Pollock, Perel, and Ms. Altieri) and Pharmacology (Drs. Pollock and Perel), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Jules Rosen, MD

Departments of Psychiatry (Drs. Sweet, Rosen, Mulsant, Pollock, Perel, and Ms. Altieri) and Pharmacology (Drs. Pollock and Perel), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Benoit H. Mulsant, MD

Departments of Psychiatry (Drs. Sweet, Rosen, Mulsant, Pollock, Perel, and Ms. Altieri) and Pharmacology (Drs. Pollock and Perel), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

Linda P. Altieri, MSN

Departments of Psychiatry (Drs. Sweet, Rosen, Mulsant, Pollock, Perel, and Ms. Altieri) and Pharmacology (Drs. Pollock and Perel), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

James M. Perel, PhD

Departments of Psychiatry (Drs. Sweet, Rosen, Mulsant, Pollock, Perel, and Ms. Altieri) and Pharmacology (Drs. Pollock and Perel), University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.

The recently promulgated Health Care Finance Administration guidelines regarding the use of neuroleptic medications for nursing home residents do not offer criteria for the frequency or nature of the required assesments of neuroleptic-induced parkinsonism (NIP). NIP has been poorly characterized in the elderly and empirical evidence on which to base guidelines for monitoring NIP is sparse. We examined the onset of NIP in 12 closely monitored, elderly psychiatric inpatients diagnosed with dementia being treated with perphenazine. Significant increases in the Simpson Extrapyramidal Side Effect Scale total score were detected by day 4 of treatment with perphenazine at a mean dose of 8.0 mg. This increase was highly correlated with the final NIP severity. This is the first report to demonstrate that routine screening "of elderly patients can detect NIP within days of the initiation of neuroleptic treatment. Early detection of NIP may allow for effective intervention to reduce the ultimate severity and associated morbidity of NIP.

Journal of Geriatric Psychiatry and Neurology, Vol. 7, No. 4, 251-253 (1994)
DOI: 10.1177/089198879400700411


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