• Levodopa is the gold standard for therapy.
• Longer acting levodopa preparations may reduce the 'end of dose' failure effect but remember the possible need for a 'kick start' with short-acting preparations, e.g. first thing in the morning.
• Ensure that a distinction is made between drug-induced involuntary movements and the tremor of Parkinson's disease.
• Keep the dose of levodopa as low as possible to avoid these drug-induced involuntary movements.
• In the elderly with a fractured hip always consider Parkinson's disease (a manifestation of disequilibrium).
• Remember the balance of psychosis and Parkinson's disease in treatment.
• Keep in mind the 'sundown' effect—patients often go psychotic as the sun goes down.
• Don't fail to attend to the needs of the family, who often suffer in silence.
• Bromocriptine and pergolide should be used very cautiously in the elderly because of possible acute psychotic reactions.
Was this article helpful?
Deal With Your Pain, Lead A Wonderful Life An Live Like A 'Normal' Person. Before I really start telling you anything about me or finding out anything about you, I want you to know that I sympathize with you. Not only is it one of the most painful experiences to have backpain. Not only is it the number one excuse for employees not coming into work. But perhaps just as significantly, it is something that I suffered from for years.