TY - JOUR
T1 - The Effects of Withdrawal of Dopaminergic Medication in Nursing Home Patients With Advanced Parkinsonism
AU - Tse, Winona
AU - Frisina, Pasquale G.
AU - Hälbig, Thomas D.
AU - Gracies, Jean Michel
AU - Liang, Lisa
AU - Tarshish, Chaim
AU - Lesser, Gerson
AU - Neufeld, Richard
AU - Koller, William C.
AU - Libow, Leslie S.
N1 - Funding Information:
This study received support, in part, from the following: the Leir Foundations, the Dextra Baldwin McGonagle Foundations, and the Joseph E. and Norma G. Saul Foundation.
Funding Information:
We thank Dr. William C. Koller for providing his inspiration, help, and support with the conception of this manuscript. We gratefully acknowledge the support, in part, for our study from the following; the Leir Foundations, the Dextra Baldwin McGonagle Foundations, and the Joseph E. and Norma G. Saul Foundation.
PY - 2008/11
Y1 - 2008/11
N2 - Objective: To determine the effects of dopaminergic medication withdrawal in an elderly, demented and minimally ambulatory nursing home population with parkinsonism in New York City. Methods: In our double-blind, randomized study, 11 patients (7 males, 4 females) were randomized into 2 groups: one group underwent levodopa medication withdrawal (experimental group) and the other group continued on their levodopa (control group). Patients were evaluated weekly over the course of a month with a neurologic examination and a series of assessment tools, including the motor UPDRS (Unified Parkinson's disease rating scale), Hoehn and Yahr staging scale, the Mini-Mental State Examination (MMSE) and the Nursing Assistant Behavioral Detection Form. Setting: An academic nursing home in New York City. Results: The patients had a mean age of 82.00 ± 10.14 years, with a mean MMSE score of 9.50 ± 6.60 out of 30.00 maximum. The control and experimental groups did not differ significantly with respect to age (P = .52), dementia severity (P = .35), nor severity of PD symptoms as measured by the UPDRS (P = .22) and Hoehn and Yahr staging (P = .65). Overall, no significant changes were observed between the control and experimental groups in cognitive, behavioral, and motor function across each time period. Of interest, 2 of the drug withdrawal patients showed modest improvements in cognitive function as measured by the MMSE. Conclusion: Our findings suggest that in patients with advanced parkinsonism and dementia, dopaminergic medication withdrawal may be a feasible way to reduce polypharmacy and potential medication-related side effects, with a minimal risk of worsening motor deterioration. Therefore, our findings may have potential implications for a medication intervention that could prevent potential deleterious side effects and improve health-related quality of life in this frail population.
AB - Objective: To determine the effects of dopaminergic medication withdrawal in an elderly, demented and minimally ambulatory nursing home population with parkinsonism in New York City. Methods: In our double-blind, randomized study, 11 patients (7 males, 4 females) were randomized into 2 groups: one group underwent levodopa medication withdrawal (experimental group) and the other group continued on their levodopa (control group). Patients were evaluated weekly over the course of a month with a neurologic examination and a series of assessment tools, including the motor UPDRS (Unified Parkinson's disease rating scale), Hoehn and Yahr staging scale, the Mini-Mental State Examination (MMSE) and the Nursing Assistant Behavioral Detection Form. Setting: An academic nursing home in New York City. Results: The patients had a mean age of 82.00 ± 10.14 years, with a mean MMSE score of 9.50 ± 6.60 out of 30.00 maximum. The control and experimental groups did not differ significantly with respect to age (P = .52), dementia severity (P = .35), nor severity of PD symptoms as measured by the UPDRS (P = .22) and Hoehn and Yahr staging (P = .65). Overall, no significant changes were observed between the control and experimental groups in cognitive, behavioral, and motor function across each time period. Of interest, 2 of the drug withdrawal patients showed modest improvements in cognitive function as measured by the MMSE. Conclusion: Our findings suggest that in patients with advanced parkinsonism and dementia, dopaminergic medication withdrawal may be a feasible way to reduce polypharmacy and potential medication-related side effects, with a minimal risk of worsening motor deterioration. Therefore, our findings may have potential implications for a medication intervention that could prevent potential deleterious side effects and improve health-related quality of life in this frail population.
KW - Parkinsonism
KW - dementia
KW - elderly population
KW - levodopa
KW - nursing home
UR - https://www.scopus.com/pages/publications/55049140787
U2 - 10.1016/j.jamda.2008.07.001
DO - 10.1016/j.jamda.2008.07.001
M3 - Article
AN - SCOPUS:55049140787
SN - 1525-8610
VL - 9
SP - 670
EP - 675
JO - Journal of the American Medical Directors Association
JF - Journal of the American Medical Directors Association
IS - 9
ER -