Tardive Dyskinesia Risk Factors: Old Age

Tardive dyskinesia was first identified in 1957, although it was not named until 1964. In 1957, antipsychotic drugs - also known as neuroleptics - had been in use in the United States for less than four years. The first such drug, chloropromazine (also known as CPZ) had been developed by medical researchers in France during the years following the Second World War. Originally, these researchers were looking to develop a new kind of sedative without narcotic effects. However, these researchers discovered that patients treated with CPZ showed improved behaviors and better cognitive function.

When introduced in the United States in 1954, CPZ was marketed by Smith, Kline & French, precursor to today's megalithic pharmaceutical corporation GlaxoSmithKline, under the brand Thorazine and touted as an "improved" version of the European drug. It was embraced by the U.S. psychiatric establishment as a more "civilized," humane alternative to the different shock therapies and surgeries that had traditionally been used to treat schizophrenia and other psychoses.

As the side effects of these neuroleptic medications started to show up and were attributed to their side effects, different drugs were developed to take their place. However, these have not eliminated the side effects; they have only delayed the onset of symptoms.

Who Is At Greatest Risk?

Symptoms of tardive dyskinesia appear in about 30 percent of patients medicated with neuroleptics, which are essentially dopamine inhibitors, or antagonists (dopamine is the neurotransmitter that facilitates communication between the brain and various cells in the body). Although relatively little study has been done on the side effects of anti-psychotic medications (and such research is not encouraged by the health care industry in the United States, which controls the U.S. health care policy and for which the sale of such medications is tremendously profitable), there are some factors which makes certain individuals more likely to develop tardive dyskinesia than others.

One of these factors is age. The majority of those with tardive dyskinesia are over the age of 55. With the "graying" of America (with current demographic trends, people over the age of 60 will constitute the majority of the U.S. population), this is perhaps one of the most significant areas of tardive dyskinesia research.

Timing

A study published in 1998 tracked a group of psychiatric patients aged 55 or older who were just beginning treatment with antipsychotic drugs. These patients were evaluated at the beginning of the study and at 90-day intervals over a period of seven-and-a-half years. The results showed that the longer these patients were treated, the greater the likelihood they would develop symptoms. By the third year of treatment with neuroleptics, over half of the subjects had developed tardive dyskinesia. The conclusion:

"Tardive dyskinesia rates for patients beginning treatment with conventional antipsychotics in their fifth decade or later are three to five times what has been found for younger patients, despite treatment with lower doses."

This research confirmed an earlier Canadian study showing a tardive dyskinesia rate among elderly patients treated with antipsychotics of over 34 percent. The Canadian study also showed that patients suffering from depression, Alzheimer's or delusional psychosis were especially susceptible.

Treatments

There are several studies today that have confirmed the results of those undertaken during the late 1990s. Unfortunately, there are few solid findings pointing toward any sort of effective treatment. In general, researchers say that prevention is the most effect way of managing tardive dyskinesia. Some say that "atypical" antipsychotics (second-generation medications), operating on serotonin as well as dopamine, is a better choice for elderly patients.

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