[Initial management of Parkinson disease]

Abstract

Treatment of Parkinson disease is symptomatic and does not influence disease progression. It is thus prescribed only when motor symptoms begin to interfere with functioning. Choice of initial treatment is crucial, and delaying introduction of levodopa can delay the occurrence of motor complications. In the elderly (older than 70 years), levodopa is preferred for initial treatment because it is more effective and better tolerated. In young patients (younger than 60 years), dopamine agonists are a better choice because, although they are less effective and have more side effects, they delay the onset of motor complications. In patients in their 60s, the choice of initial treatment depends on general health, cognitive status, and medical history. Regardless of the choice, the advantages and disadvantages of each strategy must be clearly explained to the patient. Initial prescription and subsequent modifications depend on functional problems and must be progressive. Regular physical exercise and physical therapy must be encouraged.