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Objective To determine the effects of dopaminergic medication withdrawal in an elderly, demented and minimally ambulatory nursing home population with parkinsonism in New York City. Methods In our double-blind, randomized study, 11 patients (7 males, 4 females) were randomized into 2 groups: one group underwent levodopa medication withdrawal (experimental group) and the other group continued on their levodopa (control group). Patients were evaluated weekly over the course of a month with a neurologic examination and a series of assessment tools, including the motor UPDRS (Unified Parkinson's disease rating scale), Hoehn and Yahr staging scale, the Mini-Mental State Examination (MMSE) and the Nursing Assistant Behavioral Detection Form. Setting An academic nursing home in New York City. Results The patients had a mean age of 82.00 ± 10.14 years, with a mean MMSE score of 9.50 ± 6.60 out of 30.00 maximum. The control and experimental groups did not differ significantly with respect to age ( P = .52), dementia severity ( P = .35), nor severity of PD symptoms as measured by the UPDRS ( P = .22) and Hoehn and Yahr staging ( P = .65). Overall, no significant changes were observed between the control and experimental groups in cognitive, behavioral, and motor function across each time period. Of interest, 2 of the drug withdrawal patients showed modest improvements in cognitive function as measured by the MMSE. Conclusion Our findings suggest that in patients with advanced parkinsonism and dementia, dopaminergic medication withdrawal may be a feasible way to reduce polypharmacy and potential medication-related side effects, with a minimal risk of worsening motor deterioration. Therefore, our findings may have potential implications for a medication intervention that could prevent potential deleterious side effects and improve health-related quality of life in this frail population.

Objective Essential tremor (ET) is a neurological disorder that produces motor, cognitive, and functional disability. However, there has been no investigation linking cognitive impairment with functional disability in ET. Therefore, we examine the similarities and differences between ET, Alzheimer's disease (AD), and Parkinson's disease (PD) in terms of the linkage between cognitive and functional impairment. Design Thirty-four ET, 26 PD, and 31 AD subjects were tested for cognition (Mini-Mental State Examination [MMSE]), motor disability (United Parkinson's Disease Rating Scale part III [UPDRS-III]), and functional disability (Minimum Data Set-Activities of Daily Living Section [MDS-ADL]). Results As expected, in PD and AD subjects, MDS-ADL scores significantly correlated with UPDRS-III and MMSE scores. The ET subjects showed a different pattern of functional disability with MDS-ADL scores significantly correlating only with MMSE scores, and with the orientation MMSE modalities. Conclusions Our findings highlight the need to be more cognizant of the nonmotor aspects of ET, which in some patients may be more functionally disabling than the motor features themselves.