Parkinsonism in a nursing home: underrecognition

Parkinsonism is a very common condition in the elderly, particularly the elderly demented. The authors' experience in both the in-and outpatient settings suggested that parkinsonism was generally underdiagnosed in the elderly. They evaluated the residents at a local nursing home to assess for parkinsonian signs. They then compared the findings to those noted in the charts. Blinded assessment of all nursing home residents for signs of parkinsonism was performed. A standardized evaluation instrument was used, followed by a chart review to determine if patients were taking medications that might induce the parkinsonism and whether the parkinsonism had been recognized. The authors looked separately at those patients receiving antipsychotics because of their increased risk. Twenty-seven out of 100 residents had "probable" parkinsonism, 12 of whom were severe, and 33 had "possible" parkinsonism. Of 27 residents on antipsychotics, 23 showed parkinsonian features versus 43 of 73 not on such drugs (P<.02). Only 1 patient with drug-induced parkinsonism and 3 residents with previously diagnosed Parkinson's disease had chart notes indicating that parkinsonism had been recognized.