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


METHODS
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.


CONCLUSIONS
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.
Tse
Winona
W
Department of Neurology, Mount Sinai School of Medicine, New York, NY, USA.
Frisina
Pasquale G
PG
Hälbig
Thomas D
TD
Gracies
Jean-Michel
JM
Liang
Lisa
L
Tarshish
Chaim
C
Lesser
Gerson
G
Neufeld
Richard
R
Koller
William C
WC
Libow
Leslie S
LS
D000368:Aged; D000369:Aged, 80 and over; D015259:Dopamine Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000627:therapeutic use*; D008297:Male; D009519:New York City; D009735:Nursing Homes; D010300:Parkinson Disease / Q000188:drug therapy* / Q000503:physiopathology; D012720:Severity of Illness Index; D013375:Substance Withdrawal Syndrome / Q000503:physiopathology*
D015259:Dopamine Agents; D007980:Levodopa