Journal
JOURNAL OF THE AMERICAN MEDICAL DIRECTORS ASSOCIATION
Volume 9, Issue 9, Pages 670-675Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.jamda.2008.07.001
Keywords
Parkinsonism; dementia; nursing home; levodopa; elderly population
Categories
Funding
- Leir Foundations
- Dextra Baldwin McGonagle Foundations
- Joseph E. and Norma G. Saul Foundation
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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. (J Am Med Dir Assoc 2008; 9: 670-675)
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