Opinion
Video
Understanding the Impact of Tardive Dyskinesia Across Patient Populations
Panelists discuss how the progression of undiagnosed or untreated tardive dyskinesia in older adults can severely compromise independence and quality of life, emphasizing the need for early recognition, risk factor management, and a multidisciplinary approach—including pharmacists—to ensure timely, individualized, and balanced treatment.
In this portion of the discussion, the panel explored how tardive dyskinesia (TD) progresses in older adults when left undiagnosed or untreated, and the profound effects it can have on patients’ daily lives. Although the use of first-generation antipsychotics has declined, second-generation agents still carry a risk of TD, particularly in aging populations. Many older patients may mistake TD symptoms—such as gait instability or facial movements—for normal aging, resulting in delayed diagnosis and missed opportunities for early intervention. Importantly, TD is now more treatable than ever, and early recognition leads to better treatment outcomes.
TD can gradually erode a person’s ability to live independently, affecting essential functions like chewing, swallowing, walking, and driving. This burden is compounded in individuals with chronic mental illnesses who require long-term antipsychotic therapy. Additionally, inconsistent adherence to medication regimens may increase TD risk. Health care professionals—including pharmacists, physicians, and nurse practitioners—are encouraged to proactively screen for abnormal movements, even subtle ones, in order to initiate timely treatment. Dual diagnoses involving both TD and drug-induced parkinsonism can further complicate care, requiring clinicians to balance treatments carefully, as medications for one condition can worsen the other.
The panel also addressed risk factors that increase susceptibility to TD, particularly modifiable ones. These include smoking, substance use (especially alcohol), diabetes, and the use of high-dose or first-generation antipsychotics. Other factors include a history of extrapyramidal adverse effects such as dystonia or akathisia, and intermittent medication adherence, which can sensitize dopamine receptors and heighten TD risk. Anticholinergic use, often employed to manage Parkinson-like symptoms, may also raise the likelihood of developing TD. Identifying these risks allows for earlier intervention and individualized treatment strategies aimed at minimizing the impact of TD and preserving patient quality of life.
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