Parkinson Disease: When to Initiate Dopaminergic Therapy

Lynda Nwabuobi, MD | Assistant Professor of Clinical Neurology, Weill Cornell Parkinson's Disease and Movement Disorders Institute, New York Presbyterian Hospital, New York, NY

A 66-year-old man presented to your office for his biannual visit. He is right-handed, has had Parkinson disease for 4 years, and is not taking pharmacologic therapy.

He reports that he is generally doing well in terms of mobility. However, he has trouble buttoning his shirt, tying his shoelaces, and typing on a keyboard with his right hand, although he can accomplish these tasks. He has mild imbalance but denies a history of falls. He continues to work as a lawyer and professor part-time and tends to his garden. For exercise, he rides a stationary bike 3 times a week and takes daily walks with his spouse and dog.

Upon physical examination, the patient exhibits slight hypophonia, mild masked facies, mild right hand rest tremor that reemerges with posture, mild rigidity on the right vs slight on the left, and mild to moderate bradykinesia on the right vs slight on the left. He stands up easily with his arms crossed. His gait is narrow-based and steady with reduced heel strike and arm swing on the right. He turns well, and results of a pull test were normal.