Balance Control Improves Following Replacement of Paroxetine with Venlafaxine and Levodopa in a Case of Microvascular Dementia The American Journal of.

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