In a survey of all 2069 in-patients at 14 geriatric centres, 249 patients were found to have received drugs for the treatment of parkinsonism. There was a wide variation in point prevalence which varied from 4.6% to 22.6% between centres. Levodopa, usually in combination with a.decarboxy lase inhibitor, was the most frequently prescribed drug. Compared with the recommendations for its use in Parkinson's disease, over 75% of patients received inadequate and widely spaced doses.Furthermore, dopamine antagonists were concurrently prescribed to one-third of patients who received levodopa. There was a high incidence of treatment failure (30%), and a low incidence of drug-induced dyskinesia (3%). Dementia was closely associated with the onset of parkinsonism. These findings suggest that many of these patients did not have Parkinson's disease but rather rigid-akinetic syndromes associated with degenerative brain disease. The treatment of parkinson ism in the elderly requires revaluation.
Vladimir Litvak, Alexandre Eusébio, Ashwani Jha, Robert Oostenveld, Gareth R. Barnes, Thomas Foltynie, Patricia Limousin, Ludvic Zrinzo, Marwan Hariz, Karl Friston, Peter Brown
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