ABSTRACT
BACKGROUND: Although dopamine agonists (DAs) are useful in Parkinson's disease (PD), they are not frequently used in elderly patients due to adverse effects. However, there is a lack of evidence because few elderly PD patients are enrolled in clinical trials. AIMS OF THE STUDY: The aims of this study were to analyze the reasons of DA withdrawal (DAW) in a group of PD patients in clinical practice and to identify the related factors. Specifically, we studied the effect of age, comorbidity, and polypharmacy as potential risk factors for DAW. METHODS: A retrospective chart review of the follow-up (from May, 2012 to March, 2015) of a subgroup of PD patients receiving a DA (n = 68; 60.3% males, 69.3 ± 9.2 years old) from a cohort (n = 150) previously studied in detail in 2012 was used to identify predictive factors of DAW. RESULTS: The DAW percentage was 18.2% (12/66; follow-up of 690.2 ± 232.6 days). DAW causes were cognitive impairment (3), reduction therapy (3), hallucinations (2), dyskinesia (2), and excessive diurnal somnolence (2). Only a higher levodopa daily dose (HR 1.003; 95% CI 1.001-1.006; P = 0.044) was an independent predictor of DAW after adjustment for other explanatory variables. CONCLUSIONS: The frequency of DAW was low. Advanced age alone is not a contraindication to the administration of DAs.
Subject(s)
Dopamine Agonists/adverse effects , Parkinson Disease/drug therapy , Age Factors , Aged , Cognition Disorders/chemically induced , Cohort Studies , Comorbidity , Contraindications , Dopamine Agonists/administration & dosage , Female , Humans , Male , Polypharmacy , Predictive Value of Tests , Retrospective Studies , Risk FactorsABSTRACT
Diferentes síntomas gastrointestinales, como salivación excesiva, deterioro y otros trastornos de las piezas dentarias, disfagia, gastroparesia, reflujo gastroesofágico, estreñimiento, dificultades en la defecación o pérdida de peso, son frecuentes en todos los estadios evolutivos de la enfermedad de Parkinson y afectan al menos a un tercio de los pacientes. Estos síntomas reflejan la disfunción del sistema nervioso entérico, siendo el estómago uno de los órganos donde más precozmente se deposita la alfa-sinucleína. Otros factores, como la disfunción de estructuras del sistema nervioso central como el núcleo motor dorsal del nervio vago, factores hormonales o efectos secundarios derivados del consumo de fármacos antiparkinsonianos están implicados en su origen. El presente artículo revisa en detalle aspectos epidemiológicos, fisiopatológicos, clínicos y de manejo terapéutico de los diferentes síntomas gastrointestinales en la enfermedad de Parkinson (AU)
Different gastrointestinal symptoms, such as excessive salivation, deterioration and other disorders affecting the teeth, dysphagia, gastroparesis, gastroesophageal reflux, constipation, difficult defecation or loss of weight are frequent events in all the stages of the development of Parkinsons disease and affect at least a third of the patients. These symptoms reflect the dysfunction of the enteric nervous system, and the stomach is one of the organs where alphasynuclein is first deposited. Other factors, such as the dysfunction of structures in the central nervous system like the dorsal motor nucleus of the vagal nerve, hormonal factors or secondary effects deriving from the consumption of antiparkinsonian drugs, are involved in its origin. The present article offers a detailed review of the epidemiological, pathophysiological, clinical and therapeutic management aspects of the different gastrointestinal symptoms in Parkinsons disease (AU)
Subject(s)
Female , Humans , Male , Parkinson Disease/diagnosis , Parkinson Disease/drug therapy , Gastroparesis/diagnosis , Gastroparesis/drug therapy , Sialorrhea/diagnosis , Sialorrhea/drug therapy , Deglutition Disorders/diagnosis , Deglutition Disorders/drug therapy , Gastroesophageal Reflux/diagnosis , Gastroesophageal Reflux/drug therapy , alpha-Synuclein , Constipation/etiology , Constipation/therapy , Vagus Nerve/physiopathology , Enteric Nervous System/physiopathology , Tooth Avulsion , Weight Loss , Burning Mouth Syndrome , Temporomandibular Joint Dysfunction SyndromeSubject(s)
Blindness, Cortical/chemically induced , Methanol/poisoning , Occipital Lobe/drug effects , Acidosis/chemically induced , Adult , Blindness, Cortical/diagnostic imaging , Combined Modality Therapy , Humans , Magnetic Resonance Imaging , Male , Necrosis , Neuroimaging , Occipital Lobe/diagnostic imaging , Occipital Lobe/pathology , Psychomotor Agitation/etiology , Tomography, X-Ray Computed , Visual Cortex/diagnostic imaging , Visual Cortex/drug effects , Visual Cortex/pathologyABSTRACT
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