d‐Amphetamine in Elderly Patients Refractory to Rehabilitation Procedures

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Abstract
This report concerns the use of d-amphetamine in 88 elderly in-patients who initially failed to respond to rehabilitation procedures. These patients exhibited characteristics of the Poor Motivation Syndrome (PMS), not associated with depression or dementia. The syndrome was seen 5 times more frequently in women. d-Amphetamine was given for 3 wk in increasing dosage (2.5-10.0 mg twice daily). The responses were scored according to mobility, self-care and motivation. Of the 88 patients, 48 improved and another 28 were discharged who would otherwise have remained dependent nursing cases. An unexpected finding was that 17 patients showed an age-related resistance to the effects of the drug (P < 0.05). The likelihood of a beneficial response also diminished with increasing age (P < 0.01). Side effects were in the psychiatric sphere; they occurred in 23 patients early in treatment and were not age-related; the drug was withdrawn. Thus treatment with d-amphetamine should be restricted to selected patients who satisfy the diagnostic criteria of PMS, and administration should be carefully supervised. With these safeguards, a substantial proportion of patients previously refractory to rehabilitation will show improvement, become more independent and may be discharged from the hospital in a much more active, less dependent state of mind and body.

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