L.C. is a 78-year-old man with a 3-year history of Parkinson disease (PD). He is a retired engineer, is married,
and lives with his wife in a small farming community. He has four adult children who live close by.
Since
his last visit to the clinic 6 months ago, L.C. reports that his tremors are "about the same" as they were;
however, further questioning reveals that he feels his gait is perhaps a little more unsteady, and his fatigue
is slightly more noticeable. L.C. is also concerned about increased drooling. Among the medications L.C.
takes are carbidopa-levodopa 25/100 mg (Sinemet) four times daily and amantadine (Symmetrel) 100 mg
at breakfast and bedtime. On the previous visit the Sinemet was increased from three to four times daily.
He reports that he has become very somnolent with this regimen and that his dyskinetic movements
appear to be worse just after taking his carbidopa-levodopa (Sinemet).
What is PD?
PD is a chronic, progressive neurologic disease associated with the degeneration of the dopamine
producing neurons in the substantia nigra of the midbrain, which enables us to move normally and
smoothly. The cause of nigral cell degeneration is not known. Once cell loss in the substantia nigra
reaches 80%, manifestations appear. The onset of PD is gradual and insidious, with steady worsening
of motor function as time progresses.
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