The art of treating Parkinson disease in the older patient.
BACKGROUND
Parkinson disease (PD) is a neurodegenerative disorder that increases sharply after the sixth decade. There are many disorders in the elderly that exhibit some parkinsonian signs that can be confused with PD.


OBJECTIVE
This article discusses the diagnostic and management issues of PD in the elderly patient.


CONCLUSIONS
Levo-dopa (L-dopa) therapy is the cornerstone of treatment for PD in the elderly. After 5-8 years of treatment, monitor complications such as fluctuations and dyskinesia usually occur and adjunct therapy may be required. Dopamine agonists can be used to smooth out motor fluctuations and amantadine is sometimes useful for dyskinesia. However, the adverse drug effects of adjunct therapy in the elderly are more common than with L-dopa alone, and risks need to be weighed up against benefits. Nonmotor complications including dementia, psychosis, depression, autonomic dysfunction and somnolence are common and require special attention. Late stage problems such as aspiration, difficulties with activities of daily living or recurrent falls require a multidisciplinary approach. Anticholinergic drugs such as benztropine and benzhexol are best avoided because of the high risk of major side effects.
Chan
Daniel Kam Yin
DK
University of New South Wales, Aged Care and Rehabilitation, Bankstown Hospital, New South Wales. daniel.chan@swasahs.nsw.gov.au
D000368:Aged; D000978:Antiparkinson Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D001315:Australia; D018491:Dopamine Agonists / Q000008:administration & dosage / Q000627:therapeutic use; D004409:Dyskinesia, Drug-Induced / Q000188:drug therapy; D005194:Family Practice / Q000379:methods; D005260:Female; D005853:Geriatrics / Q000379:methods; D006801:Humans; D007980:Levodopa / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use; D008297:Male; D009043:Motor Activity / Q000187:drug effects; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy*; D016896:Treatment Outcome
D000978:Antiparkinson Agents; D018491:Dopamine Agonists; D007980:Levodopa