Daniel Weintraub1, Claire Chiang2, Hyungjin Myra Kim3, Jayne Wilkinson4, Connie Marras5, Barbara Stanislawski2, Eugenia Mamikonyan6, Helen C Kales7. 1. Parkinson's Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA; Mental Illness Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. Electronic address: daniel.weintraub@uphs.upenn.edu. 2. Department of Veterans Affairs, HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA. 3. Department of Veterans Affairs, HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA; Center for Statistical Consultation and Research, University of Michigan, Ann Arbor, MI, USA. 4. Parkinson's Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA, USA; Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 5. Morton and Gloria Shulman Movement Disorder Centre and the Edmond J Safra Program in Parkinson's Disease, Toronto Western Hospital, University of Toronto, Canada. 6. Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA. 7. Department of Veterans Affairs, HSR&D Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Psychiatry, University of Michigan, Ann Arbor, MI, USA; Geriatric Research, Education and Clinical Center, VA Ann Arbor Healthcare System, Ann Arbor, MI, USA.
Abstract
OBJECTIVE: To determine if antipsychotic (AP) use in Parkinson disease (PD) patients is associated with increased physical morbidity. METHODS: Veterans Health Administration data (1999-2010) was used to examine physical morbidity risk associated with AP use in idiopathic PD patients with stable recent physical health. We compared 180-day morbidity rates in patients initiating an AP with matched non-AP users who survived for 180 days (matched on age, sex, race, index year, presence and duration of dementia, PD duration, delirium, hospitalization, Charlson Comorbidity Index, and new non-psychiatric medications; covarying for psychosis). Outcomes were 180-day emergency department (ED), and inpatient and outpatient visits. RESULTS: There were 6,679 matched PD pairs. Any AP use was associated with an increased risk of ED visit (HR: 1.64, 95% CI: 1.51, 1.77), inpatient care (HR: 1.58, 95% CI: 1.46, 1.71), and outpatient visits (IRR: 1.08, 95% CI: 1.05, 1.12). The risk was significantly higher for atypical AP use compared with nonuse for all three morbidity outcomes, and was similar for atypical and typical AP use. CONCLUSIONS: Any AP use, and atypical AP use, are associated with significantly increased physical morbidity risk in PD patients, as evidenced by increased ED, inpatient, and outpatient visits. These findings, which require replication, extend the risk associated with use of APs in this population from mortality to a broader range of adverse outcomes, and further highlight the need to use APs cautiously in PD patients. Published by Elsevier Inc.
OBJECTIVE: To determine if antipsychotic (AP) use in Parkinson disease (PD) patients is associated with increased physical morbidity. METHODS: Veterans Health Administration data (1999-2010) was used to examine physical morbidity risk associated with AP use in idiopathic PDpatients with stable recent physical health. We compared 180-day morbidity rates in patients initiating an AP with matched non-AP users who survived for 180 days (matched on age, sex, race, index year, presence and duration of dementia, PD duration, delirium, hospitalization, Charlson Comorbidity Index, and new non-psychiatric medications; covarying for psychosis). Outcomes were 180-day emergency department (ED), and inpatient and outpatient visits. RESULTS: There were 6,679 matched PD pairs. Any AP use was associated with an increased risk of ED visit (HR: 1.64, 95% CI: 1.51, 1.77), inpatient care (HR: 1.58, 95% CI: 1.46, 1.71), and outpatient visits (IRR: 1.08, 95% CI: 1.05, 1.12). The risk was significantly higher for atypical AP use compared with nonuse for all three morbidity outcomes, and was similar for atypical and typical AP use. CONCLUSIONS: Any AP use, and atypical AP use, are associated with significantly increased physical morbidity risk in PDpatients, as evidenced by increased ED, inpatient, and outpatient visits. These findings, which require replication, extend the risk associated with use of APs in this population from mortality to a broader range of adverse outcomes, and further highlight the need to use APs cautiously in PDpatients. Published by Elsevier Inc.
Authors: Bastiaan R Bloem; Jan H L Ypinga; Allison Willis; Colleen G Canning; Roger A Barker; Marten Munneke; Nienke M De Vries Journal: J Parkinsons Dis Date: 2018 Impact factor: 5.568
Authors: Alberto J Espay; Michael T Guskey; James C Norton; Bruce Coate; Joaquin A Vizcarra; Clive Ballard; Stewart A Factor; Joseph H Friedman; Anthony E Lang; Niccole J Larsen; Candace Andersson; Doral Fredericks; Daniel Weintraub Journal: Mov Disord Date: 2018-11-02 Impact factor: 10.338