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KEY CONCEPTS

KEY CONCEPTS

  • image Awareness and continuous surveillance of motor and nonmotor symptoms in combination with thoughtful consideration of initial and adjunctive therapies with adjustment of drug dosing throughout the course of idiopathic Parkinson disease (PD) is required to optimize long-term therapeutic outcomes, minimize adverse effects, and improve quality of life.

  • image In general, treatment should be initiated when the disease begins to interfere with activities of daily living, employment, or quality of life.

  • image Surgery is an option for patients who require additional symptomatic relief or control of motor complications.

  • image Anticholinergic medication can be useful for mild symptoms of PD but, due to anticholinergic side effects, should be used with caution in the elderly and in those with pre-existing cognitive difficulties.

  • image Monotherapy, amantadine and the irreversible monoamine oxidase type B (MAO-B) inhibitors provide symptomatic benefit, but less than that of dopamine agonists or carbidopa/levodopa (L-dopa).

  • image Carbidopa/L-dopa is the most effective medication for symptomatic treatment.

  • image Most carbidopa/L-dopa–treated patients will develop motor complications (eg, fluctuations and dyskinesias).

  • image MAO-B inhibitors (irreversible and reversible) and catechol-O-methyltransferase (COMT) inhibitors are useful add-on therapies to attenuate motor fluctuations in carbidopa/L-dopa–treated patients.

  • image Amantadine is a useful add-on agent to attenuate dyskinesias.

  • image Dopamine agonists are effective and, compared to L-dopa, associated with less risk of developing motor complications but more risk of causing psychiatric symptoms, such as hallucinations and impulse control disorders.

PRECLASS ACTIVITY

Preclass Engaged Learning Activity

Perform a literature search to identify recent treatment guidelines for motor (eg, treatment of motor symptoms, fluctuations, or dyskinesias) or nonmotor symptoms (eg, treatment of depression, psychosis, orthostatic hypotension, sleep disturbances) of Parkinson disease. Select a guideline and summarize the findings and recommendations. This activity is intended to build your literature search and evaluation skills and ability to summarize evidence-based or guideline recommendations.

INTRODUCTION

The presence of bradykinesia, along with tremor at rest, rigidity, and postural instability (instability of balance) are considered the hallmark motor features of idiopathic Parkinson disease (PD), a disorder of the extrapyramidal system. These clinical features of PD were adeptly described in 1817 by James Parkinson.1

EPIDEMIOLOGY

Up to 1 million individuals in the United States have PD. The approximate annual incidence of PD (ie, number of persons diagnosed with PD per year) is age-dependent and ranges from 10 per 100,000 persons in the sixth decade of life (ie, 50-59 years) to 120 per 100,000 persons in the ninth decade of life (ie, 80-89 years).2 Likewise, the prevalence of PD also increases with age, affecting less than 0.5% of people in their 60s and 2.5% of those older than 80 years.3 The usual age at time of diagnosis ranges between 55 and 65 years. Overall, a higher preponderance of PD is reported among males.3

ETIOLOGY

PD occurs ...

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