Charles R. Messeloff

Effects of levodopa in parkinsonian patients with dementia

The i n d u c t i o n of confusional states, exacerbated dementias, deliria, anxiety states, elations, depressions, and frank psychoses by levodopa has been described by a number of au tho r s . The reported incidence of such psychotic disturbances has varied widely-from 3.5%’ to 55.5%.* Since levodopa has now been released for general use and is being given to large and constantly increasing numbers of parkinsonian patients, it is imperative to determine which patients are especially vulnerable to such disturbances. We have already noted, in p r e 1 i m i n a r y communications, that postenc e p h a l i t i ~ ~ ~ and demented6 patients are especially at risk in this respect, a finding endorsed by the detailed studies of Celesia and Ban.’ The effects of levodopa in postencephalitic patients, and in idiopathic patients with fully intact higher functions, have been described by us else where.*^^ The present communication is specifically concerned with the long-term effects of levodopa in parkinsonian patients with significant impairment of higher function and the ways in which concurrent dementia can modify reactions to levodopa.