Pharmacological management of Parkinson’s disease in older people

Abstract

Parkinson’s disease is a chronic neurodegenerative disorder that mainly affects older people. It is predominately recognised as a movement disorder; however, the non-motor symptoms are gaining increased recognition. Treating both motor and non-motor symptoms can be challenging. Co-morbidities, in particular dementia, polypharmacy and an increased susceptibility to adverse medication effects often necessitate a different approach to management compared to younger patients. In older people, the mainstay of treatment for motor symptoms is levodopa. However, long-term side-effects including motor fluctuations and dyskinesia can be severely disabling and may require the addition of adjunctive agents including dopamine agonists, catechol-o-methyltransferase inhibitors, monoamine oxidase-B inhibitors and amantadine. Medications can significantly improve symptoms; however, optimal management of motor and non-motor symptoms usually requires a multidisciplinary approach. In this article we present an evidence-based review of Parkinson’s disease treatments and guidance to improve clinical management and outcomes in older people.