PROBLEMS OF INITIAL THERAPY IN PARKINSON’S DISEASE IN THE ELDERLY
Abstract
The purpose of research – to study the factors limiting initial treatment with non-levodopa antiparkinsonian drugs in the elderly and to estimate the duration of their use depending on progression type of Parkinson’s disease. Material and methods. A prospective 4-year study of 52 patients with the onset of Parkinson’s disease (stage 1.5–2 according Hoehn and Yahr scale) aged 65 years and older (mean age 71.8 ± 4.3 years) has been carried out. 42 patients underwent the 24-hour blood pressure monitoring. Results and discussion. It has been revealed that 61.5 % of patients with the onset of Parkinson’s disease in the elderly had limitations on the non-levodopa drugs prescribing in the form of starting monotherapy. Orthostatic hypotension limited the use of dopamine receptor agonists in 23 % of cases. Ischemic heart disease with chronic second degree cardiac insufficiency ruled out the possibility of piribedil and amantadine preparations prescribing in 17.3 % of patients. The hydrochlorothiazide administration, the presence of closed-angle glaucoma and prostate hyperplasia/adenoma were contraindications for the administration of amantadine preparations in 19.2 %, 7.7 % and 13.5 % of cases, respectively. Patients with slow or moderate rate of disease progression took non-levodopa drugs on average 2.6 ± 0.6 years, with rapid disease progression – 0.8 ± 0.4 years. Analysis of the results of daily arterial pressure monitoring revealed the high incidence of «non-dippers» (86 %) and patients with orthostatic hypotension (42.9 %).
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ReferencesSayutina S.B. – candidate of medical sciences, assistant professor of the chair for neurology and neurosurgery, е-mail: ain2000@rambler.ru
