Should dopamine agonists be used in the treatment of Parkinson disease (PD) in patients older than 65 years?

Updated: Jan 24, 2019
  • Author: Robert A Hauser, MD, MBA; Chief Editor: Selim R Benbadis, MD  more...
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Answer

Dopamine agonists are commonly reserved for younger individuals (< 65-70 years) who are cognitively intact. When the dopamine agonist (with or without an MAO-B inhibitor) no longer provides good control of motor symptoms, levodopa can be added. However, dopamine agonists may provide good symptom control for several years before levodopa is required.

For patients aged 65-70 years, the authors make a judgment based on general health and cognitive status. The more robust and cognitively intact the patient, the more likely the authors are to treat with a dopamine agonist before levodopa and add levodopa/carbidopa when necessary. For patients with cognitive impairment and those older than 70 years—who may be prone to adverse effects, such as hallucinations, from dopamine agonists—and for those likely to require treatment for only a few years, the authors may elect not to use a dopamine agonist and instead depend on levodopa/PDI (peripheral decarboxylase inhibitor) as primary symptomatic therapy.


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