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Degenerative Diseases of the Nervous System
Published in Philip B. Gorelick, Fernando D. Testai, Graeme J. Hankey, Joanna M. Wardlaw, Hankey's Clinical Neurology, 2020
James A. Mastrianni, Elizabeth A. Harris
Neuropsychiatric symptoms may be induced by all antiparkinsonian drugs, but more commonly with anticholinergics or dopamine agonists. In patients with dementia, it may be difficult to control parkinsonism without adversely affecting mental function. Symptoms can be minimized or treated by: Eliminating unnecessary psychoactive or sedative medications.Ruling out other medical and neurologic causes of altered mental status (i.e. infections, strokes, mass lesions, medications).Withdrawing anticholinergics, dopamine agonists, amantadine, and MAO-B inhibitors as tolerated, restricting antiparkinsonian therapy to levodopa monotherapy.Using the lowest dose of antiparkinsonian medication that will provide a satisfactory motor response.
Special considerations: Parkinson’s disease
Published in Hemanshu Prabhakar, Charu Mahajan, Indu Kapoor, Essentials of Geriatric Neuroanesthesia, 2019
Aspiration pneumonia is the leading cause of death in patients with PD (12). It is related to the impairment of pharyngeal muscles and swallowing. Reduced swallowing causes secondary sialorrhea. Drugs used to treat parkinsonism have little effect on dysphagia. These patients are also known to have decreased gastric emptying, another factor that can contribute to increase aspiration risk in the perioperative period (13). Difficulty with swallowing also contributes to a poor nutritional status preoperatively, and higher risk of postoperative complications. Patients may also have gastrointestinal side effects like nausea and vomiting from antiparkinsonian medications.
Parkinson’s Disease and Rehabilitation
Published in K. Rao Poduri, Geriatric Rehabilitation, 2017
Biemiller Rachel A., Irene Hegeman Richard
In addition to depression, anxiety and apathy are common in PD and are thought to be related to the underlying disease process. While both anxiety and apathy may be associated with a depressive disorder, they may also occur in its absence [39,40]. Psychiatric symptoms related to the use of antiparkinsonian medications include drug-induced psychosis (visual hallucinations sometimes accompanied by paranoid delusions) and impulse control disorders (such as pathological gambling) [41].
Optimizing levodopa therapy, when and how? Perspectives on the importance of delivery and the potential for an early combination approach
Published in Expert Review of Neurotherapeutics, 2023
Andrew Lees, Eduardo Tolosa, Fabrizio Stocchi, Joaquim J. Ferreira, Olivier Rascol, Angelo Antonini, Werner Poewe
Earlier use of combination therapies may take advantage of the fact that antiparkinsonian medications have overlapping indications, but distinct mechanisms of action that can complement each other. Indeed, implementation of these treatment strategies and the broader use of invasive treatments has already reduced the reduced the risk of troublesome dyskinesia and improved quality of life in advanced PD [102,103]. According to our current understanding, the decision of when to combine medications will need to be individualized to patient needs and preferences [104]. For some patients who are worried about the risks of motor complications, combination therapy may be introduced while they are still in their ‘honeymoon’ period, while other patients may simply find it easier to remain on monotherapy until the first signs of wearing-off. Future work may consider how novel forms of levodopa delivery can be used in combination with other drug classes for tailored therapy.
Pharmacogenomics of drugs used to treat brain disorders
Published in Expert Review of Precision Medicine and Drug Development, 2020
Antiparkinsonian drugs are associated with the PGx activity of less than 50 genes, thus far. Different categories of antiparkinsonian drugs (anticholinergics, antihistamine ethers, tropine ethers, dopamine precursors and of donors of dopamine precursors, adamantanes, dopamine agonists, MAO-B inhibitors, COMT inhibitors) are substrates and/or inhibitors of 33 and 18 enzyme/protein gene products, respectively (inducers have not been identified so far), and are transported by 3 transporters (Table 2; Figure 6). CYP enzymes participate in the metabolism of 87% of drugs of these pharmacological categories. Antiparkinsonian drugs are major substrates of CYP3A4, CYP2C19, CYP2D6 and CYP2B6 (85%), CYP1A2 (82%), CYP3A5 (81%), UGT1A1 (69%), and UGT1A9 (68%); 38% are inhibitors of CYP3A4, 32% of CYP1A2, 25% of CYP2D6 and CYP2C19, 18% of CYP2C9, and 12% of CYP2A6 and CYP2E1. SLC22A1 (69%), SLC6A3 (63%), and ABCB1 (7%) are major transporters of most dopaminergic enhancers. Selegiline and Entacapone are associated with 47 pharmagenes, Tolcapone with 43, and L-DOPA with 36 [8, 9].
Atrial fibrillation as an important clinical condition of cognitive decline; diagnosis, comorbidities and severity of symptoms in patients with dementia
Published in Neurological Research, 2020
Natalia Niedziela, Maria Magdalena Nowak, Martyna Lis, Maria Blaszkowska, Rozalia Kośmider, Monika Adamczyk-Sowa
We reported that the intake of anxiolytics and antipsychotics in patients with dementia was significantly higher in S ≥ 4 group compared to S ≤ 3. Meanwhile, neuropsychiatric symptoms in dementia are generally connected with considerably worse outcomes for patients and their caregivers. However, the off-label use of antipsychotics and anxiolytics was observed in our patients [24]. Other studies also indicate that antipsychotics (AP) are often prescribed inappropriately and without medical indications [25]. Psychotropic drug treatment in patients with dementia should be as short as possible due to considerable adverse effects such as rapid deterioration of the already existing cognitive decline, a higher risk of cerebrovascular incidents [25], a higher mortality risk and falls or fall-related fractures [26]. Additionally, the proportion of patients with depressive disorders in our study was higher in S ≥ 4 compared to S ≤ 3. Many researches consider depressive diseases to be significant risk factors for dementia [27,28]. In a meta-analysis conducted on 49 612 participants, patients with late-life depression were affected by all types of dementia [29]. A higher intake of antiparkinsonian medications was observed in the group of patients with more symptoms compared to less symptomatic patients (S ≥ 4 vs. S ≤ 3 group). In the Korean study, 46.83% of patients with dementia received antiparkinsonian treatment [30], which is comparable to S ≥ 4 (47.92%). Some evidence suggests that levodopa may prevent cognitive deterioration in patients with Parkinson’s disease [31].