Neuroleptic Malignant Syndrome in Older Adults: A Narrative Review
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Abstract
Older adults are prone to multiple neuropsychiatric diseases, such as delirium and Parkinson’s disease, which are treated with antipsychotics and dopamine agonists. These medications may lead to neuroleptic malignant syndrome (NMS), which is a rare but life-threatening condition with a high mortality rate. The incidence of NMS tends to increase in older adults, especially in high-potency first-generation antipsychotics, such as haloperidol with dehydration status. The classic tetrad of clinical manifestations is mental status change, muscular rigidity, hyperthermia and autonomic instability. In clinical practice, the criteria for NMS diagnosis are used worldwide, including the DSM-5 criteria and Levenson’s criteria. The management of NMS comprises the withdrawal of causative agents and specific and supportive treatment. Specific treatment for NMS includes benzodiazepine, bromocriptine, amantadine, and dantrolene, according to the severity. To reduce the risk of recurrence of NMS, antipsychotic treatment may be reconsidered if there are still clear indications, but only after at least two weeks following recovery. Initiation with a low-potency atypical antipsychotic should be considered, starting at a low dose with gradual titration. Concomitant use with lithium should be avoided, as well as dehydration. In addition, close monitoring and careful clinical assessment are essential to reduce recurrent NMS. However, the knowledge of NMS in older adults is still limited. Therefore, we aimed to update the specific points of NMS in older persons, including definition, prevalence, pathophysiology, clinical manifestation, diagnosis, severity, complications, and management.
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References
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