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A 75-year-old male sees you for evaluation of a unilateral resting tremor of his right hand. The tremor resolves if he is touched on the hand by someone. His wife notes that he seems to drag his feet now, but he has no history of falls. 

Which one of the following has been shown to delay progression of his disease?

A. No currently available pharmacologic agents
B. Amantadine
C. Carbidopa/levodopa (Sinemet)
D. Rasagiline (Azilect)
E. Ropinirole


There are no currently available medications that have been shown to delay progression of Parkinson’s disease. However, guidelines recommend initiating the treatment of motor symptoms when they begin to affect the functions of daily life or decrease the quality of life. The first-line treatment for motor symptoms is carbidopa/levodopa due to its effectiveness for tremors, rigidity, and bradykinesia. It is a myth that delaying the use of levodopa will prevent a lack of efficacy later in the course of the illness, as what appears to be a lack of efficacy actually represents progression of the disease. Amantadine can be used for patients under 65 years of age who are only experiencing tremors. Monoamine oxidase inhibitors such as rasagiline and non-ergot dopamine agonists such as ropinirole are not as effective as carbidopa/levodopa for motor symptoms, but they do not cause the dyskinesias and motor fluctuations seen with levodopa. Monoamine oxidase inhibitors are considered first-line therapy for patients under age 65 with mild motor symptoms.

Ref: Halli-Tierney AD, Luker J, Carroll DG: Parkinson disease. Am Fam Physician 2020;102(11):679-691. 2) Ahlskog JE: Common myths and misconceptions that sidetrack Parkinson disease treatment, to the detriment of patients. Mayo Clin Proc 2020;95(10):2225-2234.

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