Balance Control Improves Following Replacement of
Paroxetine with Venlafaxine and Levodopa in a Case of Microvascular Dementia
The American Journal of Geriatric Pharmacotherapy 2011;9: 133-137
Jaime McDonald, Philippe Corbeil, Emmanuelle Porcher
Presented By:Deepa Patel
Doctor of Pharmacy Candidate, 2012Mercer University COPHS
July 8, 2011
Postural Instability Common complaint in geriatric patients
Can be due to several disease states, including Parkinson’s disease, microvascular dementia, in addition to numerous neurological disorders
Falls may lead to decreased quality of life and increased mortality
Study Design Case study of a single patient
Funding by NSERC (Natural Sciences and Engineering Research Council of Canada)
Study authors were fully involved in every aspect of the trial and publication and received contracts from the drug manufacturers
Patient Case 86 y/o female with a 6 month
history of frequent falls without injury and Parkinson-like syndrome of the lower limbs secondary to microvascular dementia
Bilateral rigidity Left-sided akinesia Diminshed postural adjustment
reflexes No signs of deconditinoing Moderate ischemic leukopathy
of the paraventricular white susbtance
Atropy of cerebral subcortical and cerebellar regions
Current Medications
Atorvastatin 40 mg daily ASA 81 mg daily Pantoprazole 40 mg daily Paroxetine 20 mg daily
Vision, BP and HR normal Ruled out: hypothyroidism,
peripheral neuropathy, arterial insufficiecy
Microvascular Dementia Usually attributed to diseases that may
lead to ischemia such as diabetes mellitus and dyslipidemia
Neurotransmitters implicated in gait disorders include Serotonin Norepinephrine Dopamine
Serotonin Involvement in balance control is
postulated as SSRI withdrawal has detrimental effects on balance
Norepinephrine Involvement in balance control is
attributed to regulation of the mental processes of attention and concentration
Dopamine Highly debated relationship with balance
control, but evidence of postural instability in Parkinson’s disease strengthens the hypothesis that dopamine contributes, particulary when patients have eyes open
Intervention
ResultsPrimary outcome: Center of Pressure (CoP) measured over 20 seconds, average of three trials per treatment intervention performed
Conclusion Most improvement in balance control
when using combination therapy of Venlafaxine (SNRI) and Levodopa
Author suggests that for geriatric patients on antidepressants, addition or switching medications with differing mechanisms of action may be an effective option for helping alleviate balance control issues
CommentaryStrengths of Study Did not use
medications on the Beer’s list
Dosing was appropriate for disease state and patient age
Tapering of medication was appropriate
Weaknesses of Study Single patient study Most patients with
microvascular dementia present with numerous concomitant disease states including diabetes mellitus and hypertension, however this patient did not report such illnesses
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