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Factors to Consider in the Selection of Dopamine Agonists for Older Persons with Parkinson’s Disease

  • Mark Dominic LattEmail author
  • Simon Lewis
  • Olfat Zekry
  • Victor S. C. Fung
Current Opinion

Abstract

Dopamine agonists (DAs) are frequently used in the management of Parkinson’s disease (PD), a complex multisystem disorder influenced substantially by age-related factors. Over 80% of PD patients present after age 60 years and may have clinical features exacerbated by age-related comorbidities or decline in physiological compensatory mechanisms. Pharmacotherapy for motor symptoms in older persons is more likely to involve exclusive use of levodopa combined with a peripheral decarboxylase inhibitor throughout the course of the illness. Non-ergot DAs, such as pramipexole, rotigotine and ropinirole, may be used as de novo monotherapy for the control of motor symptoms in older persons, although they are less efficacious than levodopa therapy. DAs may also be considered as adjunct therapy in older persons when motor symptoms are no longer adequately controlled by levodopa or when motor fluctuations and dyskinesia appear. DAs may be used cautiously in older persons with cognitive impairment and orthostatic hypotension but should be avoided when there is a history or risk of psychosis or impulse control disorders.

Notes

Compliance with Ethical Standards

Funding

No specific funding was received for this work by Mark Dominic Latt, Simon Lewis, Olfat Zekry or Victor S. C. Fung.

Conflict of interest

Mark Dominic Latt and Olfat Zekry report no conflicts of interest or additional disclosures. Simon Lewis reports honoraria from Stada and Teva. Victor S. C. Fung is a member of advisory boards for Abbvie, Allergan, Ipsen, Merz, Stada, Teva and UCB.

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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Mark Dominic Latt
    • 1
    Email author
  • Simon Lewis
    • 2
  • Olfat Zekry
    • 3
  • Victor S. C. Fung
    • 4
  1. 1.Geriatric Medicine DepartmentUniversity of Sydney, Royal Prince Alfred HospitalCamperdownAustralia
  2. 2.Parkinson’s Disease Research Clinic, Brain and Mind CentreUniversity of SydneySydneyAustralia
  3. 3.Department of Pharmacy, Royal Prince Alfred HospitalUniversity of SydneySydneyAustralia
  4. 4.Department of Neurology, Westmead HospitalUniversity of SydneySydneyAustralia

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