CLINICAL-ASSESSMENT OF EXTRAPYRAMIDAL SIGNS IN NURSING-HOME PATIENTS GIVEN ANTIPSYCHOTIC MEDICATION

Background: We sought to quantify the relationship, between antipsycho tic drug use and clinical evidence of extrapyramidal dysfunction in a large population of elderly nursing home patients. Methods: Subjects w ere 251 residents (mean age, 84.1 years; range, 65 to 105 years) who w ere taking psychoactive drugs in 12 long-term care facilities. Patient characteristics and all medication use (both scheduled and as needed) were measured during a 1-month observation period. We then performed neuropsychological and functional testing on residents who received an y psychoactive medications during the study month. The presence of rig idity, bradykinesia, or masklike facies was assessed in each patient b y a research assistant who was unaware of diagnoses arid medication us e. Results: The parkinsonian signs studied were found in 127 (50.6%) o f these residents. Using logistic regression modeling to adjust for po tential confounding, we found this outcome to be increased more than t hreefold in patients who took low-potency neuroleptics (odds ratio [OR ], 3.49 for greater than or equal to 50 mg/d of chlorpromazine-type dr ugs; 95% confidence interval [CI], 1.28 to 9.57) and more than sixfold for use of 1 mg/d or more of haloperidol (OR, 6.42; 95% CI, 2.16 to 1 9.04). Age, gender, and use of nonneuroleptic psychoactive drugs were not associated with an increase in parkinsonian signs. Conclusions: Cl inical evidence of extrapyramidal dysfunction is three to six times mo re common in institutionalized elderly patients given antipsychotic me dication than in comparable patients not using such drugs. Its risk is substantially increased even in patients given low-potency chlorproma zine-type drugs, as well as those taking haloperidol. The effect is no t explained by age or mental status and is not seen with other psychoa ctive medications. The expected frequency of parkinsonian symptoms can help to inform the balancing of risks vs therapeutic effect when the use of all drugs in this class is considered.