First Expert Consensus Recommendations for Tardive Dyskinesia in Long-Term Care Settings

At the Society for Post-Acute and Long-Term Care Medical Association (PALTmed) PALTC26 Annual Conference in Anaheim, California, experts presented the first consensus recommendations focused on the screening, diagnosis, and treatment of tardive dyskinesia (TD) among older adults in long-term care settings. The recommendations were developed through a multidisciplinary Delphi panel and address persistent gaps in recognizing and managing TD in this higher-risk population.¹

"To date, there has been limited practical guidance tailored specifically to the screening, diagnosis and treatment of tardive dyskinesia in the long-term care setting," said Sanjay Keswani, MD, the chief medical officer of Neurocrine Biosciences. "The consensus recommendations provide structured guidance for clinicians caring for residents in these environments.”

Older adults in long-term care are at an elevated risk for TD for several reasons, including prolonged exposure to dopamine receptor blocking agents, advanced age, polypharmacy, and complex comorbidities.² Management of TD may be further complicated in residents who are nonambulatory, cognitively impaired, or unable to reliably report symptoms. For these reasons, the Delphi panel was convened to develop recommendations that reflect the clinical complexity of TD and support a more consistent, structured approach to patient care.

"Residents in long-term care settings often present with overlapping medical and psychiatric complexities that can make tardive dyskinesia difficult to consistently recognize and manage," said Amita Patel, MD, the poster's lead author and psychiatrist at the Joint Township District Memorial Hospital in St. Mary's, Ohio. "Through this process, the panel reached clear consensus on practical, implementable recommendations that support evidence-based diagnosis and appropriate use of VMAT2 inhibitors. These recommendations provide clinicians with a structured framework to guide screening and treatment decisions to help improve outcomes for this especially vulnerable population."

The panel identified several key considerations to support routine and consistent TD screening in long-term care settings, such as (1) Use of the Abnormal Involuntary Movement Scale (AIMS) for screening and assessing TD; (2) Quarterly screening for residents treated with dopamine receptor blocking agents; and (3) Regular assessment of the impact of TD on residents' well-being, including feedback from residents, family members, caregivers, and their care team.

Panelists also agreed that TD should be treated with a vesicular monoamine transporter 2 (VMAT2) inhibitor in long-term care settings and identified several treatment-selection factors particularly relevant in these environments:

• Formulation flexibility for residents who experience dysphagia or difficulty swallowing.
• Simplified administration.
• Consideration of polypharmacy and potential drug-drug interactions.
• Availability of clinical data in adults aged 65 years and older.

At the conference, Neurocrine Biosciences also presented a first-of-its-kind post-hoc analysis from the KINECT‑PRO study, in which valbenazine (Ingrezza) capsules demonstrated meaningful improvements in patient‑reported TD impact among adults aged 65 years and older. In adults aged 65 and older, once-daily Ingrezza was associated with robust patient-reported improvements in TD symptoms, quality of life and functional impairment at week 24. Patient-reported outcomes also demonstrated reduced social and emotional burden, with improvements in total TDIS scores exceeding the established threshold for clinically meaningful change.

“The KINECT-PRO findings demonstrate clinically meaningful patient-reported improvements in the impact of tardive dyskinesia with Ingrezza in adults aged 65 years and older. Together, this guidance and evidence help support more informed treatment decisions in this population that may be at higher risk for tardive dyskinesia,” said Keswani.

Ingrezza is approved for the treatment of adults with TD and has been studied extensively in adults aged 65 years and older. It is the only VMAT2 inhibitor without a cautious dosing recommendation in this population and is also the only treatment that offers a therapeutic dose from day 1 with no required titration.

The post-hoc analysis of the KINECT-PRO study complements the consensus recommendations by demonstrating the real-world impact of Ingrezza treatment in older adults. KINECT-PRO is the first and only clinical study to specifically evaluate and investigate patient-reported improvement with Ingrezza for TD using multiple validated scales, including the Tardive Dyskinesia Impact Scale. This analysis adds to the growing body of evidence supporting the appropriateness, efficacy, tolerability, and established safety profile of Ingrezza in this patient population.

References

1. Neurocrine Biosciences presents first expert consensus recommendations for tardive dyskinesia in long-term care settings. News release. March 26, 2026. Accessed March 26, 2026. https://neurocrine.gcs-web.com/news-releases/news-release-details/neurocrine-biosciences-presents-first-expert-consensus

2. Bron M, Aweh G, Jen E, Patel A. Real-world claims analysis to characterize the burden of tardive dyskinesia in long-term care settings. Neurol Ther. 2025;14(5):2217-2226.