Parkinson's disease: diagnosis and treatment.
Parkinson's disease is a common neurodegenerative disorder that can cause significant disability and decreased quality of life. The cardinal physical signs of the disease are distal resting tremor, rigidity, bradykinesia, and asymmetric onset. Levodopa is the primary treatment for Parkinson's disease; however, its long-term use is limited by motor complications and drug-induced dyskinesia. Dopamine agonists are options for initial treatment and have been shown to delay the onset of motor complications. However, dopamine agonists are inferior to levodopa in controlling motor symptoms. After levodopa-related motor complications develop in advanced Parkinson's disease, it is beneficial to initiate adjuvant therapy with dopamine agonists, catechol O-methyltransferase inhibitors, or monoamine oxidase-B inhibitors. Deep brain stimulation of the subthalamic nucleus has been shown to ameliorate symptoms in patients with advanced disease. Depression, dementia, and psychosis are common psychiatric problems associated with Parkinson's disease. Psychosis is usually drug induced and can be managed initially by reducing antiparkinsonian medications. The judicious use of psychoactive agents may be necessary. Consultation with a subspecialist is often required.
Rao
Shobha S
SS
University of Texas Southwestern Medical School at Dallas Family Medicine Residency Program, Dallas, Texas 75390, USA. shobha.rao@utsouthwestern.edu
Hofmann
Laura A
LA
Shakil
Amer
A
D000465:Algorithms; D000978:Antiparkinson Agents / Q000627:therapeutic use; D065098:Catechol O-Methyltransferase Inhibitors; D003937:Diagnosis, Differential; D018491:Dopamine Agonists / Q000627:therapeutic use; D006801:Humans; D008996:Monoamine Oxidase Inhibitors / Q000627:therapeutic use; D018696:Neuroprotective Agents / Q000627:therapeutic use; D010300:Parkinson Disease / Q000150:complications / Q000175:diagnosis* / Q000628:therapy*
D000978:Antiparkinson Agents; D065098:Catechol O-Methyltransferase Inhibitors; D018491:Dopamine Agonists; D008996:Monoamine Oxidase Inhibitors; D018696:Neuroprotective Agents