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Abstract：
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.
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.
摘要：
背景：关于与帕金森病痴呆（PDD）相关的神经精神症状的最佳治疗方法的证据有限。选择性5-羟色胺再摄取抑制剂（SSRIs）广泛用于认知功能障碍的老年人的情绪障碍和行为症状，但它们对PDD患者的疗效有限。SSRIs对止血的影响也不清楚。该报告描述了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。
方法：一名患有PDD的86岁女性因精神状态改变被送往急诊科，广义弱点，左小腿肿胀.西酞普兰在4周前因行为改变而开始服用，并在服用前2天因为过度疲劳而停止服用。在介绍时,她的血浆钠水平为123mg/dL。脑计算机断层扫描显示与年龄相关的变化。多普勒超声显示左小腿DVT。患者接受高渗盐水和静脉注射肝素治疗。钠正常化后,她服用多奈哌齐和阿哌沙班后出院。在后续行动中,她的钠保持正常,认知和行为明显改善。
结论：患有帕金森病的老年人对精神药物的不良反应敏感，包括SSRIs,不推荐使用PDD中行为症状的一线药物。在患有功能减退和多种合并症的老年患者中启动SSRIs后，医师需要评估患者出血或血栓形成的危险因素。身体活动也应尽可能保持。
方法：一名患有PDD的86岁女性因精神状态改变被送往急诊科，广义弱点，左小腿肿胀.西酞普兰在4周前因行为改变而开始服用，并在服用前2天因为过度疲劳而停止服用。在介绍时,她的血浆钠水平为123mg/dL。脑计算机断层扫描显示与年龄相关的变化。多普勒超声显示左小腿DVT。患者接受高渗盐水和静脉注射肝素治疗。钠正常化后,她服用多奈哌齐和阿哌沙班后出院。在后续行动中,她的钠保持正常,认知和行为明显改善。
结论：患有帕金森病的老年人对精神药物的不良反应敏感，包括SSRIs,不推荐使用PDD中行为症状的一线药物。在患有功能减退和多种合并症的老年患者中启动SSRIs后，医师需要评估患者出血或血栓形成的危险因素。身体活动也应尽可能保持。
