Specificities of the treatment of Parkinson's disease in the elderly

Abstract

The treatment of Parkinson's disease (PD) in subjects over 70 years old is simpler than in younger subjects for correcting the consequences of dopamine deficiency, but more complex with regard to symptoms resulting from non-dopaminergic lesions (axial symptoms, cognitive decline). Due to the lower risk of occurrence of motor fluctuations and severe dyskinesia, L-DOPA is the dopaminergic treatment with the best ratio of efficacy to side effects, and can be used without reservation. Treatment of non-dopaminergic symptoms is still disappointing. Apart from a partial beneficial effect of functional rehabilitation programmes, no treatment was demonstrated to be really effective for correcting dysarthria, swallowing disorders or impairment of gait and balance. Some efficacy in reducing the cognitive deficit in PD has been recently shown by cholinergic drugs, but their functional efficacy and their mid-term impact remain poor. Analysis of the different factors involved in the genesis of symptoms in PD (with the putative interest of the use of L-DOPA as a 'diagnostic tool'), and of the comorbidity usually enables cautious and pragmatic solutions to be found.