American Board of Internal Medicine (ABIM) Certification Practice Exam

What is the preferred initial therapy for older patients with Parkinson's?

1. Dopamine agonists

2. Levodopa

3. Amantadine

4. Deep brain stimulation

The correct answer is: Levodopa

The preferred initial therapy for older patients with Parkinson's disease is levodopa. This choice is based on the medication’s effectiveness in alleviating motor symptoms of the disease. Levodopa is a precursor to dopamine and is particularly beneficial because it directly addresses the underlying dopamine deficiency that occurs in Parkinson's. Older patients often have a higher burden of motor symptoms and may be more sensitive to the adverse effects of medications, which makes levodopa an appropriate first-line treatment. It typically has a well-established safety profile and is effective at improving rigidity, bradykinesia, and tremor, which are the hallmark symptoms of Parkinson's disease. Dopamine agonists can be used, but they may lead to more side effects like confusion, hallucinations, or impulse control disorders, particularly in older adults. Therefore, while they might be considered in younger patients or those with early-stage Parkinson’s, levodopa is generally preferred for older individuals. Other options like amantadine and deep brain stimulation are used in specific scenarios but are not first-line treatments in the initial management of Parkinson's for older patients. Amantadine, for instance, might be used for certain specific symptoms or in mild cases, while deep brain stimulation is typically reserved for