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Review

Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review

1
Departments of Psychiatry, Central and North West London NHS Foundation Trust, London NW1 3AX, UK
2
Knowledge and Library Services, Central and North West London NHS Foundation Trust, London NW1 3AX, UK
3
Old Age Psychiatry, Central and North West London NHS Foundation Trust, Uxbridge UB8 3NN, UK
*
Author to whom correspondence should be addressed.
Academic Editor: Maurits Van den Noort
Received: 7 April 2021 / Revised: 19 May 2021 / Accepted: 23 May 2021 / Published: 26 May 2021
(This article belongs to the Special Issue Drug-Induced Diseases in the Elderly)
Background: Parkinsonism is a common side-effect of antipsychotic drugs especially in older adults, who also present with a higher frequency of neurodegenerative disorders like Idiopathic Parkinson’s disease (IPD). Distinguishing between antipsychotic-induced parkinsonism (AIP) and IPD is challenging due to clinical similarities. Up to 20% of older adults may suffer from persisting parkinsonism months after discontinuation of antipsychotics, suggesting underlying neurodegeneration. A review of the literature on AIP in older adults is presented, focusing on epidemiology, clinical aspects, and management. Methods: A literature search was undertaken on EMBASE, MEDLINE and PsycINFO, for articles on parkinsonism induced by antipsychotic drugs or other dopamine 2 receptor antagonists in subjects aged 65 or older. Results: AIP in older adults is the second most common cause of parkinsonism after IPD. Older age, female gender, exposure to high-potency first generation antipsychotics, and antipsychotic dosage are the main risk factors. The clinical presentation of AIP resembles that of IPD, but is more symmetrical, affects upper limbs more, and tends to have associated motor phenomena such as orofacial dyskinesias and akathisia. Presence of olfactory dysfunction in AIP suggests neurodegeneration. Imaging of striatal dopamine transporters is widely used in IPD diagnosis and could help to distinguish it from AIP. There is little evidence base for recommending pharmacological interventions for AIP, the best options being dose-reduction/withdrawal, or switching to a second-generation drug. Conclusions: AIP is a common occurrence in older adults and it is possible to differentiate it from IPD. Further research is needed into its pathophysiology and on its treatment. View Full-Text
Keywords: parkinsonism; antipsychotic drugs; older adults parkinsonism; antipsychotic drugs; older adults
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MDPI and ACS Style

Wisidagama, S.; Selladurai, A.; Wu, P.; Isetta, M.; Serra-Mestres, J. Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review. Medicines 2021, 8, 24. https://0-doi-org.brum.beds.ac.uk/10.3390/medicines8060024

AMA Style

Wisidagama S, Selladurai A, Wu P, Isetta M, Serra-Mestres J. Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review. Medicines. 2021; 8(6):24. https://0-doi-org.brum.beds.ac.uk/10.3390/medicines8060024

Chicago/Turabian Style

Wisidagama, Sharadha, Abiram Selladurai, Peter Wu, Marco Isetta, and Jordi Serra-Mestres. 2021. "Recognition and Management of Antipsychotic-Induced Parkinsonism in Older Adults: A Narrative Review" Medicines 8, no. 6: 24. https://0-doi-org.brum.beds.ac.uk/10.3390/medicines8060024

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