The effects of withdrawal of dopaminergic medication in nursing home patients with advanced parkinsonism.

Abstract

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.

• Authors: Winona Tse, Pasquale G Frisina, Thomas D Hälbig, Jean-Michel Gracies, Lisa Liang, Chaim Tarshish, Gerson Lesser, Richard Neufeld, William C Koller, Leslie S Libow
• Journal: Journal of the American Medical Directors Association (J Am Med Dir Assoc) Vol. 9 Issue 9 Pg. 670-5 (Nov 2008) ISSN: 1538-9375 [Electronic] United States
• PMID: 18992700 (Publication Type: Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Chemical References

• Dopamine Agents
• Levodopa

Topics

• Aged
• Aged, 80 and over
• Dopamine Agents (administration & dosage, therapeutic use)
• Double-Blind Method
• Female
• Humans
• Levodopa (administration & dosage, therapeutic use)
• Male
• New York City
• Nursing Homes
• Parkinson Disease (drug therapy, physiopathology)
• Severity of Illness Index
• Substance Withdrawal Syndrome (physiopathology)