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.

Effectiveness of In-person Tele-support Management on Perceived Burden, Health-promoting Practices, and Sense of Coherence among Caregivers of Older Adults with Parkinson’s Disease

“…Caregiving had a negative impact on their physical, psychological, and social status (66.7%), and 53.8% did not get any help from another one in caregiving (did not have respite care). Table (2) revealed that financial support was the most common support area need (97.4%) reported by PD caregivers, followed by information about Parkinson's disease and about the available community resources (84.6% each), about instruments that facilitate caring and about proper management of disease's motor symptoms (76.9% each). Need to find private time for themselves, and managing negative emotions resulted from caregiving experience were reported by caregivers in significant percent (71.8%, 69.2% respectively).…”

“…In addition, the rate of progression of PD varies, along with different combination, range, and severity of symptoms leading to uncertainty in the trajectory of the disease process, which is presently neither reversible nor curable. Multiple treatment options available are used to help the sufferers maintain independence and improve quality of life, not singularly treats all symptoms most come with the risk of significant motor, non-motor, and psychological side effects [2] .…”

Extracellular Vesicles, Cell-Penetrating Peptides and miRNAs as Future Novel Therapeutic Interventions for Parkinson’s and Alzheimer’s Disease

“…Studies have shown that more regular and targeted dosing is required after 3–5 years of the disease and the progressive loss of independence, dyskinesia, confusion and hallucinations [ 73 , 74 ]. There are also reported side effects associated with pharmacological interventions including oxidative stress in patients, gastrointestinal problems, nausea and peripheral oedema [ 71 , 72 , 75 , 76 , 77 ].…”

Farewell to the Geriatric Therapeutics Review series: the end of the beginning

“…This is a topic of increasing relevance and importance, given the increased life expectancy of people with HIV 7 . The second article is a review of the prevention, diagnosis, and management of vitamin B 12 deficiency, which is a common but often under‐recognised problem in older people that may have serious consequences if left untreated 8 . Fittingly, this final article is written by Heidelberg Repatriation Hospital aged‐care pharmacist Nadia Mouchaileh.…”