Parkinsonism and exposure to neuroleptic drugs in elderly people living in institutions.

Three-hundred fifty-two randomly selected residents, aged over 65 years, of 42 representative long-term care institutions in a defined geographic area of south-western France, were assessed for demographic characteristics, drug intake, and motor and cognitive status. Neuroleptic drug intake is described and demographic variables and motor and cognitive status are analyzed according to exposure to neuroleptics and presence of parkinsonism. Exposure to neuroleptics was considered as a "risk factor" for parkinsonism, and the risk (proportion) of parkinsonism attributable to neuroleptics calculated. Twenty-one percent of subjects were exposed to neuroleptics, of whom 27% took more than one. Subjects taking neuroleptics were significantly younger and more cognitively impaired. About 30% of subjects taking neuroleptics had parkinsonism (6.25% of the sample). Postural and action tremors were more frequent than resting tremor, and asymmetry of parkinsonian signs was found in 25%. The mean dosage taken by exposed subjects with parkinsonism was found to be twice that of those without. The proportion of cases of parkinsonism attributable to neuroleptics in institutions was 19%. Our results clearly show that neuroleptic drug use in institutionalized elderly persons is associated with a high risk for parkinsonism.