Community and long-term care management of Parkinson's disease in the elderly: focus on monoamine oxidase type B inhibitors.

摘要: Parkinson’s disease affects up to 1 million people in the US, most of them elderly. Motor and non-motor symptoms can be significantly disabling point necessitating institutionalisation. Age-related changes drug absorption, distribution, metabolism excretion complicate treatment elderly patients with disease. General management principles include initiation medication at low doses gradual titration based on clinical effects, avoidance certain classes drugs (e.g. anticholinergics), attention polypharmacy its risk for potentially toxic interactions. Levodopa remains efficacious anti-Parkinson’s should cornerstone therapy patient. Use dopamine receptor agonists, amantadine anticholinergic is limited by high psychotoxicity. Catechol-O-methyltransferase inhibitors may used augment levodopa setting ‘wearing off’ (i.e. motor fluctuations). Monoamine oxidase type B (MAO-B) across spectrum severity, but selegiline (deprenyl), prototype this class, characterised erratic bioavailability parent conversion amphetamine metabolites that increase adverse events. A new orally disintegrating tablet formulation overcomes some these limitations. Rasagiline a new, selective, second-generation MAO-B inhibitor chemically metabolically distinct from selegiline. The favourable safety profile rasagiline once-daily maximise adherence improve outcomes.