Department of Internal Medicine, University of Tabuk, B.O.Box:4279, Tabuk City, 71491, Tabuk, Saudi Arabia.
BMC Geriatr. 2023 Jun 1;23(1):344. doi: 10.1186/s12877-023-04057-z.
Evidence is limited regarding the optimal therapeutic approach for neuropsychiatric symptoms associated with Parkinson's disease dementia (PDD). Selective serotonin reuptake inhibitors (SSRIs) are widely used for mood disorders and behavioral symptoms in older adults with cognitive impairment, but they have limited efficacy in patients with PDD. The effect of SSRIs on hemostasis is also unclear. This report describes a patient with PDD who developed deep venous thrombosis (DVT) and hyponatremia after initiating citalopram treatment.
An 86-year-old woman with PDD presented to our emergency department with altered mental status, generalized weakness, and left lower leg swelling. Citalopram was begun 4 weeks previously for behavioral changes and was discontinued 2 days before presentation because of excessive fatigue. At presentation, her plasma sodium level was 123 mg/dL. Brain computed tomography showed age-related changes. Doppler ultrasound revealed a DVT in the left lower leg. The patient was treated with hypertonic saline and intravenous heparin. After normalization of her sodium, she was discharged on donepezil and apixaban. At follow-up, her sodium remained normal, and her cognition and behavior were noticeably improved.
Older adults with Parkinson's disease are sensitive to adverse effects of psychotropic agents, including SSRIs, which are not recommended first-line agents for behavioral symptoms in PDD. Upon initiating SSRIs in older patients with functional decline and multiple comorbidities, physicians need to evaluate the patient's risk factors for bleeding or thrombosis. Physical activities should also be maintained as much as possible.
帕金森病痴呆（PDD）相关神经精神症状的最佳治疗方法证据有限。选择性 5-羟色胺再摄取抑制剂（SSRIs）广泛用于有认知障碍的老年人群的情绪障碍和行为症状，但在 PDD 患者中的疗效有限。SSRIs 对止血的影响也不清楚。本报告描述了一例 PDD 患者在开始西酞普兰治疗后出现深静脉血栓形成（DVT）和低钠血症。
一位 86 岁的女性 PDD 患者因精神状态改变、全身无力和左小腿肿胀到我院急诊科就诊。4 周前因行为改变开始服用西酞普兰，并在就诊前 2 天因过度疲劳停用。就诊时，其血浆钠水平为 123mg/dL。脑计算机断层扫描显示为与年龄相关的改变。多普勒超声显示左小腿 DVT。患者接受高渗盐水和静脉肝素治疗。钠恢复正常后，给予多奈哌齐和阿哌沙班出院。随访时，她的钠仍正常，认知和行为明显改善。
帕金森病老年患者对精神药物的不良反应敏感，包括 SSRIs，不建议将其作为 PDD 行为症状的一线药物。在开始使用 SSRIs 治疗功能下降和合并多种疾病的老年患者时，医生需要评估患者出血或血栓形成的风险因素。还应尽可能保持身体活动。
