abx 17 - tabish60102

[ArchivalUser]

A 76-year-old man is evaluated for right upper-extremity tremor of 1-year's duration. The patient is right-handed, and the tremor occurs when he walks and when he sits with his hand resting in his lap. He also has decreased dexterity involving the right hand and impaired handwriting. Over the past 6 months, he has needed help dressing.

On examination, he has mildly hypophonic speech and decreased facial expression, as well as slowness, rigidity, and reduced arm swing on the right side. His balance is normal.

Which of the following is the most appropriate management for this patient?

A Selegiline
B Carbidopa-levodopa
C Amantadine
D Pramipexole

[ArchivalUser]

bb

[ArchivalUser]

BB

[ArchivalUser]

b

[ArchivalUser]

Correct Answer = B)
Key Points

* Carbidopa-levodopa is the first-line treatment for patients older than 70 years with new-onset Parkinson's disease.
* Complications associated with the use of dopamine agonists, such as somnolence, drug-induced psychosis, and dizziness, are more common in patients older than 70 years.

The symptoms and signs in this patient are consistent with Parkinson's disease. His disease is associated with limitations in his activities of daily living and pain. Carbidopa-levodopa is the first-line treatment for patients older than 70 years with new-onset Parkinson's disease. Dopamine agonists like pramipexole are used as initial monotherapy in younger patients, in whom the side effect profile is milder. Complications associated with the use of dopamine agonists, such as somnolence, drug-induced psychosis, and dizziness, are more common in patients older than 70 years. Amantadine is not as potent as carbidopa-levodopa and should not be used as first-line therapy in the elderly. Selegiline has a weak symptomatic effect and will likely not substantially affect this patient's functional status.