The Elderly and Other Vulnerable Populations

Medication adverse effects in general are more likely to develop in the elderly (Nolan et al., 1988). People who are elderly and people suffering from dementia are at extreme risk for many different adverse effects when exposed to neuroleptics. A recent study of administrative data from a health care insurer in the United States examined 959 cases of patients at least 45 years old who had been diagnosed with dementia, 

The vulnerability of the elderly is nowhere more apparent than in regard to TD. The two most recent editions of the Diagnostic and Statistical Manual of Mental Disorders (APA, 1994, 2000) provide a consensus statement that sums up the degree of risk in the elderly, noting prevalence figures reported up to 50% and an incidence of 25%-30% after an average of 1 year s cumulative exposure to neuroleptic medication. This is so hard to believe that it is worth paraphrasing More than one-quarter of the elderly will develop TD within the first year of exposure  

In addition to age, prior brain damage probably increases the risk of TD (Breggin, 1983b Chouinard et ah, 1979 McKeith et ah, 1992). Cohen and Cohen (1993) found a correlation between TD and prior organic brain disorder. 

Jeste et ah (1993), in an ongoing prospective study, found that 26% of middle-aged and elderly patients developed TD after 12 months. Reviewing the literature on neuroleptic withdrawal, the authors found that almost 60 percent of the patients withdrawn from neuroleptics did not relapse over a mean period of 6 months. They concluded, It seems 

Jeste et al. (1993) emphasized, The potential seriousness of neuroleptic-induced TD warrants obtaining competent, informed consent to treatment from patients or guardians. They recommended that consent be periodically renewed and cited other sources to confirm their position. 

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