From the Guidelines
Dyskinesias can occur in Alzheimer's disease, particularly in later stages or as a side effect of certain medications, such as antipsychotics. Dyskinesias in Alzheimer's typically manifest as involuntary, abnormal movements that may include chorea (jerky movements), dystonia (sustained muscle contractions), or myoclonus (sudden muscle jerks) 1. These movement disorders often emerge as the disease affects multiple brain regions beyond those primarily involved in memory. Medications used to treat Alzheimer's symptoms, particularly antipsychotics like risperidone or quetiapine prescribed for behavioral symptoms, can sometimes cause drug-induced dyskinesias as a side effect, with a diminished risk of developing extrapyramidal symptoms and tardive dyskinesia compared to typical antipsychotic agents 1.
Some key points to consider in managing dyskinesias in Alzheimer's patients include:
- Evaluating whether the dyskinesias are medication-related or disease-related, as management approaches differ 1
- Reducing or changing medications if the movements are drug-induced, while other cases may require specific treatments targeting the movement disorder itself
- Using atypical antipsychotic agents, such as risperidone or quetiapine, which have a lower risk of causing extrapyramidal symptoms and tardive dyskinesia compared to typical antipsychotic agents 1
- Monitoring patients for signs of dyskinesias, particularly when using antipsychotic medications, and adjusting treatment plans as needed to minimize the risk of these movement disorders 1.
It's essential to weigh the potential benefits of medications against the risk of dyskinesias and other side effects, and to regularly assess patients for signs of these movement disorders 1.
From the FDA Drug Label
The FDA drug label does not answer the question.
From the Research
Dyskinesias in Alzheimer's Disease
- Dyskinesias, particularly tardive dyskinesia, can occur in patients with Alzheimer's disease, especially those treated with antipsychotic medications 2, 3, 4.
- The development of tardive dyskinesia in Alzheimer's patients may be associated with greater degenerative changes in the substantia nigra 2.
- The incidence of persistent emergent tardive dyskinesia in elderly patients with dementia, including Alzheimer's, treated with risperidone was found to be relatively low, at 2.6% 3.
Risk Factors and Treatment
- Risk factors for tardive dyskinesia in older patients include age, early extrapyramidal symptoms, cumulative amounts of neuroleptics, duration of neuroleptic treatment, and history of alcohol abuse and/or dependence 4.
- Preventing tardive dyskinesia is of primary importance, and clinicians should follow best practice for prescribing antipsychotic medication, including limiting the prescription for specific indications, using the minimum effective dose, and minimising the duration of therapy 5.
- Treatment options for tardive dyskinesia include the withdrawal of antipsychotic medication if clinically feasible, switching to a second-generation antipsychotic with a lower D2 affinity, and the use of VMAT2 inhibitors such as deutetrabenazine and valbenazine 5, 6.