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The key points for treatment of Parkinsonism in older persons

Fulvio Lauretani, Andrea Ticinesi, Tiziana Meschi, Marcello Maggio
  • Fulvio Lauretani
    Internal Medicine and Critical Subacute Care Unit, Laboratory of Disability Prevention, Department of Geriatrics and Rehabilitation, University-Hospital of Parma; Department of Clinical and Experimental Medicine, University of Parma, Italy | flauretani@ao.pr.it
  • Andrea Ticinesi
    Internal Medicine and Critical Subacute Care Unit, Laboratory of Disability Prevention, Department of Geriatrics and Rehabilitation, University-Hospital of Parma; Department of Clinical and Experimental Medicine, University of Parma, Italy
  • Tiziana Meschi
    Internal Medicine and Critical Subacute Care Unit, Laboratory of Disability Prevention, Department of Geriatrics and Rehabilitation, University-Hospital of Parma; Department of Clinical and Experimental Medicine, University of Parma, Italy
  • Marcello Maggio
    Department of Clinical and Experimental Medicine, University of Parma; Department of Clinical Geriatrics and Geriatric Rehabilitation, University-Hospital of Parma, Italy

Abstract

Signs and symptoms of Parkinsonism have a high prevalence in older persons. Parkinsonism is associated with negative outcomes in the elderly and there is still uncertainty about when and how to start levodopa in these conditions. The diagnosis of idiopathic Parkinson disease is often not pursued in the oldest old. The coexistence of both motor and cognitive impairment is the strongest factor limiting the initiation of treatment with levodopa and/or dopamine agonists in a geriatric setting, given the possibility of producing psychotic symptoms, such as visual hallucinations. It seems reasonable to perform at least one attempt to administer levodopa in older persons with parkinsonism, especially when symptoms and motility disorders are evident, in order to try to obtain an improvement in walking speed and balance. Important signs that should guide treatment for Parkinsonism in older persons are the presence of line-pipe rigidity and cogwheel rigidity.

Keywords

Parkinsonism; cognitive impairment; cogwheel rigidity; lead-pipe rigidity.

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Submitted: 2016-07-12 23:41:17
Published: 2017-01-11 13:14:20
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Copyright (c) 2017 Fulvio Lauretani, Andrea Ticinesi, Tiziana Meschi, Marcello Maggio

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