Phys · geriatric
Parkinson S Disease IN Older Adults
Also known as Parkinson S Disease IN Older Adults · parkinson s disease in older adults · Parkinson's disease · idiopathic Parkinson's disease · PD · paralysis agitans · levodopa-induced dyskinesia · Parkinson's disease psychosis
Consultant-physician depth guide to Parkinson's disease in older adults for FRACP DWE/DCE preparation — MDS clinical diagnostic criteria, levodopa pharmacology and motor complications (wearing-off, dyskinesia, on–off fluctuations), device-assisted therapies (apomorphine, levodopa–carbidopa intestinal gel, foslevodopa–foscarbidopa subcutaneous infusion, deep brain stimulation), non-motor symptoms (cognitive decline, psychosis, autonomic failure, falls, freezing of gait), pimavanserin for Parkinson's disease psychosis, palliative care at end of life, and adjustments for frailty, multimorbidity and polypharmacy. Structured for FRACP DWE/DCE, MRCP and ABIM preparation.
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Mrs Y is a 78-year-old with eight years of akinetic-rigid Parkinson's disease. She is admitted with aspiration pneumonia, her usual levodopa has been withheld because she is nil by mouth, and she is now stiffer, febrile, and confused. The registrar has written metoclopramide for the nausea. The questions that decide her survival are whether you reinstate the levodopa safely, swap the antiemetic before it worsens her parkinsonism, and assess the swallowing that caused the aspiration in the first place.[2][4]
Hold those three levers — never omit levodopa, never block dopamine, find the precipitant — and the whole topic falls into place.[2]
You have read the opening of this topic. The complete unit — every section and its primary-source references — is part of the Physician Medicine fellowship atlas.
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- [1]Postuma RB, Berg D, Stern M, et al. MDS clinical diagnostic criteria for Parkinson's disease. Mov Disord, 2015.PMID 26474316
- [2]Armstrong MJ, Okun MS Diagnosis and Treatment of Parkinson Disease: A Review. JAMA, 2020.PMID 32044947
- [3]Okun MS Deep-brain stimulation for Parkinson's disease. N Engl J Med, 2012.PMID 23075179
- [4]Cummings J, Isaacson S, Mills R, et al. Pimavanserin for patients with Parkinson's disease psychosis: a randomised, placebo-controlled phase 3 trial. Lancet, 2014.PMID 24183563
- [5]Aarsland D, Creese B, Politis M, et al. Cognitive decline in Parkinson disease. Nat Rev Neurol, 2017.PMID 28257128
- [6]Goldman JG, Sieg E Cognitive Impairment and Dementia in Parkinson Disease. Clin Geriatr Med, 2020.PMID 32222308
- [7]Pahwa R, Lyons KE Levodopa-related wearing-off in Parkinson's disease: identification and management. Curr Med Res Opin, 2009.PMID 19228103
- [8]Kwok JYY, Smith R, Chan LML, et al. Managing freezing of gait in Parkinson's disease: a systematic review and network meta-analysis. J Neurol, 2022.PMID 35244766
- [9]Mouchaileh N, Cameron J Device-assisted therapies for Parkinson disease. Aust Prescr, 2025.PMID 40040736
- [10]Walker RW Palliative care and end-of-life planning in Parkinson's disease. J Neural Transm (Vienna), 2013.PMID 23328948
- [11]Akbar U, McQueen RB, Bemski J, et al. Prognostic predictors relevant to end-of-life palliative care in Parkinson's disease and related disorders: a systematic review. J Neurol Neurosurg Psychiatry, 2021.PMID 33789923
- [12]Blair HA Foslevodopa/Foscarbidopa: A Review in Advanced Parkinson's Disease. CNS Drugs, 2025.PMID 40198538