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Parkinson's disease and other movement disorders
Editorial Comment
The American Journal of Geriatric Pharmacotherapy
Editorial Comment Parkinson’s Disease and Other Movement Disorders This issue of the journal contains reviews and original research in the field of movement disorders, including Parkinson’s disease (PD). Guay1 provides an extensive overview of the efficacy and tolerability of tetrabenazine in the management of various hyperkinetic movement disorders. Although tetrabenazine is indicated only for the treatment of Huntington’s chorea in the United States, it has been used for a variety of hyperkinetic movement disorders, including tardive dyskinesia. PD is a common neurodegenerative disorder with a prevalence that is likely to increase as the population ages and life expectancy grows. Eng and Weltyy2 and Wood et al3 review the management of nonmotor symptoms and comorbidities in patients with PD, which include cognitive impairment, depression, gastrointestinal dysfunction, hallucinosis, psychosis, orthostatic hypotension, sleep disturbances, and swallowing disorders. Management of these potentially debilitating symptoms is a challenge that requires thoughtful attention, intervention, and follow-up. Treatment is often guided by clinical experience or expert opinion, in part because of the relative shortage of evidence-based literature on the management of nonmotor symptoms of PD compared with motor symptoms. Thus, these articles make a valuable contribution to our understanding. The original research papers by Tarrants et al4 and Wei et al5 provide insight into factors affecting adherence to and utilization patterns of medications for PD. Clinicians may have a general sense of adherence and the factors that influence it in their individual practices and communities. However, the outcomes data reported in these papers are derived from systematic analyses and reflect a broad view of adherence and utilization trends in the United States. Tarrants et al found that rates of adherence to PD medications vary by drug class, information that may be useful in clinical decision-making. Wei et al discovered that almost half of Medicare beneficiaries with PD do not use any medication for PD, a finding that may come as a surprise. Identification of various factors that affect medication use is likely to help in the development of intervention standards. The information contained in this issue of the journal is intended to help clinicians better manage their patients with PD and other movement disorders, and I am confident that readers will find it both timely and useful. Jack J. Chen, PharmD, FCCP, FASCP, BCPS, CGP Associate Professor (Neurology) Movement Disorders Center Schools of Medicine and Pharmacy Loma Linda University Loma Linda, California
REFERENCES 1. Guay DR. Tetrabenazine, a monoamine-depleting drug used in the treatment of hyperkinetic movement disorders. Am J Geriatr Pharmacother. 2010;8:331–373. 2. Eng ML, Welty TE. Management of hallucinations and psychosis in Parkinson’s disease. Am J Geriatr Pharmacother. 2010;8:316–330. 3. Wood LD, Neumiller JJ, Setter SP, Dobbins EK. Clinical review of treatment options for select nonmotor symptoms of Parkinson’s disease. Am J Geriatr Pharmacother. 2010;8:294–315. 4. Tarrants ML, Denarié MF, Castelli-Haley J, et al. Drug therapies for Parkinson’s disease: A database analysis of patient compliance and persistence. Am J Geriatr Pharmacother. 2010;8:374–383. 5. Wei YJ, Stuart B, Zuckerman IH. Use of antiparkinson medications among elderly Medicare beneficiaries with Parkinson’s disease. Am J Geriatr Pharmacother. 2010;8:384–394.
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August 2010
293
The American Journal of Geriatric Pharmacotherapy
Editorial Comment Parkinson’s Disease and Other Movement Disorders This issue of the journal contains reviews and original research in the field of movement disorders, including Parkinson’s disease (PD). Guay1 provides an extensive overview of the efficacy and tolerability of tetrabenazine in the management of various hyperkinetic movement disorders. Although tetrabenazine is indicated only for the treatment of Huntington’s chorea in the United States, it has been used for a variety of hyperkinetic movement disorders, including tardive dyskinesia. PD is a common neurodegenerative disorder with a prevalence that is likely to increase as the population ages and life expectancy grows. Eng and Weltyy2 and Wood et al3 review the management of nonmotor symptoms and comorbidities in patients with PD, which include cognitive impairment, depression, gastrointestinal dysfunction, hallucinosis, psychosis, orthostatic hypotension, sleep disturbances, and swallowing disorders. Management of these potentially debilitating symptoms is a challenge that requires thoughtful attention, intervention, and follow-up. Treatment is often guided by clinical experience or expert opinion, in part because of the relative shortage of evidence-based literature on the management of nonmotor symptoms of PD compared with motor symptoms. Thus, these articles make a valuable contribution to our understanding. The original research papers by Tarrants et al4 and Wei et al5 provide insight into factors affecting adherence to and utilization patterns of medications for PD. Clinicians may have a general sense of adherence and the factors that influence it in their individual practices and communities. However, the outcomes data reported in these papers are derived from systematic analyses and reflect a broad view of adherence and utilization trends in the United States. Tarrants et al found that rates of adherence to PD medications vary by drug class, information that may be useful in clinical decision-making. Wei et al discovered that almost half of Medicare beneficiaries with PD do not use any medication for PD, a finding that may come as a surprise. Identification of various factors that affect medication use is likely to help in the development of intervention standards. The information contained in this issue of the journal is intended to help clinicians better manage their patients with PD and other movement disorders, and I am confident that readers will find it both timely and useful. Jack J. Chen, PharmD, FCCP, FASCP, BCPS, CGP Associate Professor (Neurology) Movement Disorders Center Schools of Medicine and Pharmacy Loma Linda University Loma Linda, California
REFERENCES 1. Guay DR. Tetrabenazine, a monoamine-depleting drug used in the treatment of hyperkinetic movement disorders. Am J Geriatr Pharmacother. 2010;8:331–373. 2. Eng ML, Welty TE. Management of hallucinations and psychosis in Parkinson’s disease. Am J Geriatr Pharmacother. 2010;8:316–330. 3. Wood LD, Neumiller JJ, Setter SP, Dobbins EK. Clinical review of treatment options for select nonmotor symptoms of Parkinson’s disease. Am J Geriatr Pharmacother. 2010;8:294–315. 4. Tarrants ML, Denarié MF, Castelli-Haley J, et al. Drug therapies for Parkinson’s disease: A database analysis of patient compliance and persistence. Am J Geriatr Pharmacother. 2010;8:374–383. 5. Wei YJ, Stuart B, Zuckerman IH. Use of antiparkinson medications among elderly Medicare beneficiaries with Parkinson’s disease. Am J Geriatr Pharmacother. 2010;8:384–394.
EPJKBNKPQIBSN
7PMVNFt/VNCFS
August 2010
293