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Understanding Parkinson's disease: an update on current diagnostic and treatment strategies.
J Am Med Dir Assoc. 2006 Sep; 7(7 Suppl 2):4-10.JA

Abstract

Diagnosis of PD can be difficult in elderly patients because some of the key PD symptoms also may be manifestations of normal aging. Asymmetrical symptom onset, resting tremor,and sustained response to levodopa are key features that suggest a diagnosis of PD. For most patients, PD progresses fairly slowly. The goal of treatment is to control symptoms, thereby allowing quality of life and functional ability to be maintained. Pharmacologic therapies are primarily targeted at stimulating dopaminergic receptors, either by increasing the levels of dopamine or by using dopamine agonists. Levodopa, the main therapy for PD and a precursor of dopamine, has a short half-life and is quickly metabolized.Accordingly, decarboxylase inhibitors, like carbidopa, are almost always administered with levodopa to prevent breakdown in the periphery. Catechol-O-methyltransferase (COMT)inhibitors, which increase dopamine levels by inhibiting the metabolism of levodopa and dopamine, recently have become available, including a tablet containing carbidopa, levodopa,and entacapone. Other pharmaceutical therapies for PD include dopamine agonists, monoamine oxidase-B (MAO-B) inhibitors, anticholinergic agents, and amantadine. Dopamine agonists, anticholinergic agents, and amantadine are associated with an increased risk of hallucinations or other adverse events in elderly patients; therefore, use of these should be avoided in this population. Surgical management, particularly deep brain stimulation(DBS), is an option for patients who are refractory to pharmaceutical therapy. Although patients may not need levodopa as an initial treatment, over time most patients will require this drug to control symptoms. With chronic levodopa therapy, patients ultimately experience a wearing off in levodopa response and other motor complications. Management of wearing off is a significant challenge in the treatment of patients with advanced PD.

Authors

No affiliation info available

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

17948613

Citation

Pahwa, Rajesh. "Understanding Parkinson's Disease: an Update On Current Diagnostic and Treatment Strategies." Journal of the American Medical Directors Association, vol. 7, no. 7 Suppl 2, 2006, pp. 4-10.
Pahwa R. Understanding Parkinson's disease: an update on current diagnostic and treatment strategies. J Am Med Dir Assoc. 2006;7(7 Suppl 2):4-10.
Pahwa, R. (2006). Understanding Parkinson's disease: an update on current diagnostic and treatment strategies. Journal of the American Medical Directors Association, 7(7 Suppl 2), 4-10.
Pahwa R. Understanding Parkinson's Disease: an Update On Current Diagnostic and Treatment Strategies. J Am Med Dir Assoc. 2006;7(7 Suppl 2):4-10. PubMed PMID: 17948613.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Understanding Parkinson's disease: an update on current diagnostic and treatment strategies. A1 - Pahwa,Rajesh, PY - 2007/10/24/pubmed PY - 2007/10/24/medline PY - 2007/10/24/entrez SP - 4 EP - 10 JF - Journal of the American Medical Directors Association JO - J Am Med Dir Assoc VL - 7 IS - 7 Suppl 2 N2 - Diagnosis of PD can be difficult in elderly patients because some of the key PD symptoms also may be manifestations of normal aging. Asymmetrical symptom onset, resting tremor,and sustained response to levodopa are key features that suggest a diagnosis of PD. For most patients, PD progresses fairly slowly. The goal of treatment is to control symptoms, thereby allowing quality of life and functional ability to be maintained. Pharmacologic therapies are primarily targeted at stimulating dopaminergic receptors, either by increasing the levels of dopamine or by using dopamine agonists. Levodopa, the main therapy for PD and a precursor of dopamine, has a short half-life and is quickly metabolized.Accordingly, decarboxylase inhibitors, like carbidopa, are almost always administered with levodopa to prevent breakdown in the periphery. Catechol-O-methyltransferase (COMT)inhibitors, which increase dopamine levels by inhibiting the metabolism of levodopa and dopamine, recently have become available, including a tablet containing carbidopa, levodopa,and entacapone. Other pharmaceutical therapies for PD include dopamine agonists, monoamine oxidase-B (MAO-B) inhibitors, anticholinergic agents, and amantadine. Dopamine agonists, anticholinergic agents, and amantadine are associated with an increased risk of hallucinations or other adverse events in elderly patients; therefore, use of these should be avoided in this population. Surgical management, particularly deep brain stimulation(DBS), is an option for patients who are refractory to pharmaceutical therapy. Although patients may not need levodopa as an initial treatment, over time most patients will require this drug to control symptoms. With chronic levodopa therapy, patients ultimately experience a wearing off in levodopa response and other motor complications. Management of wearing off is a significant challenge in the treatment of patients with advanced PD. SN - 1538-9375 UR - https://www.unboundmedicine.com/medline/citation/17948613/Understanding_Parkinson's_disease:_an_update_on_current_diagnostic_and_treatment_strategies_ L2 - https://medlineplus.gov/parkinsonsdisease.html DB - PRIME DP - Unbound Medicine ER -