DRUG-INDUCED PARKINSONIAN SYMPTOMS IN THE ELDERLY

帕金森病症状可导致大量发病，包括福尔斯和 骨折，自我照顾能力下降，过早 制度化。 对于药物的使用频率知之甚少- 使用抗精神病药后会出现诱发性帕金森病症状（DIPS） （抗精神病）药物。 这个问题是由于年龄的关注- 相关的多巴胺能功能下降，大量使用精神抑制剂， 老年人，以及DIPS与特发性 帕金森病，导致错误的诊断和治疗， 额外的药物。 DIPS代表了一个更频繁， 药物在衰老过程中的潜在不良反应， 教育干预，如果更多地了解其患病率， 相关的风险因素。 拟议的项目是一项利用数据库进行的流行病学研究 由研究小组开发，包含所有报销的医疗保健， 从1980年到1990年，新泽西的整个医疗补助人口都遇到了这种情况。 1988年的索赔记录，并附有1988年所有参与人的完整索赔记录。 州老年人和残疾人药房援助计划（PAAD）， 以及新泽西医疗保险（A和B部分）的索赔文件， 同期业绩 病例对照设计将确定所有新的接受者， 药物通常用于治疗帕金森症状，以及所有 被诊断为患有帕金森症状的患者。 控件将被 来自同一批医疗补助接受者。 的相对 将测量先前使用特定精神抑制剂的频率 在病例和对照组中，使用两种相关的 胃复安和丙氯拉嗪 这项研究将产生优势比，将确定风险的增加， 在服用特定的神经抑制剂的患者中， 与未接受这些药物的患者相比， 所有 分析将按年龄、性别、居住在疗养院， 医疗补助资格期间的医疗补助处方索赔数量。 各种常用的精神抑制剂之间的风险差异将是 定义以及年龄、剂量和使用持续时间作为效应的作用 修饰语 还将研究卫生服务研究问题， 包括处方医生和医疗机构的特征， 更高的DIPS率。

Parkinsonian symptoms can cause substantial morbidity, including falls and fractures, decline in capacity for self-care, and premature institutionalization. Little is known about the frequency with which drug- induced parkinsonian symptoms (DIPS) occur following use of neuroleptic (anti-psychotic) medication. This problem is of concern because of age- related decrease in dopaminergic function, the heavy use of neuroleptics in the elderly, and the potential confusion of DIPS with idiopathic Parkinson's disease, leading to erroneous diagnosis and treatment with an additional medication. DIPS represents one of the more frequent and potentially disabling adverse drug effects in aging which could be targeted for educational intervention if more were known about its prevalence and associated risk factors. The proposed project is an epidemiologic study making use of a database developed by the study team that contains all reimbursed health care encounters for the entire Medicaid population of New Jersey from 1980 to 1988, supplemented by the complete claims histories of all participants in the state's Pharmacy Assistance for the Aged and Disabled (PAAD) program, and the claims file for Medicare (Parts A and B) for New Jersey for the same period. A case-control design will identify all new recipients of medications commonly used to treat parkinsonian symptoms, as well as all recipients diagnosed as having parkinsonian symptoms. Controls will be drawn from the same population of Medicaid recipients. The relative frequency of prior use of specific neuroleptic agents will be measured among cases and controls, as will the frequency of use of two related drugs, metoclopramide and prochlorperazine. The study will generate odds ratios that will identify the increase in risk of developing parkinsonian symptoms in patients given specific neuroleptic medications relative to patients who do not receive these agents. All analyses will be stratified by age, gender, residence in nursing homes, and by numbers of Medicaid prescription claims during Medicaid eligibility. Differences in risk among the various commonly used neuroleptics will be defined as well as the role of age, dose, and duration of use as effect modifiers. Health services research questions will also be studied, including characterization of prescribers and health-care settings with high rates of DIPS.