The use of dopamine agonists in very elderly patients with Parkinson's disease

BACKGROUND: Controversy exists regarding the use of dopamine receptor agoni sts in elderly patients with Parkinson's disease because of concern about a high rate of intolerable side effects. METHODS: A retrospective chart review was used to examine our experience wi th dopamine agonist use in the very elderly by identifying patients in our Parkinson's disease database who were over the age of 80 years and who had received agonists. Sixty-nine patients were identified who had 120 separate trials of agonist therapy. Successful treatment with the agonist was defin ed as maintenance of the agonist for a minimum of 6 months. RESULTS: The overall success rate among the very elderly for an agonist tri al was 46%. Success rates for individual agonists were 15 of 27 (56%) bromo criptine, 18 of 34 (53%) pergolide, 17 of 43 (40%) pramipexole, and 5 of 16 (31%) ropinirole. In successful trials with bromocriptine, the mean daily dose was 12.8 mg, mean duration of treatment was 40 months, and mean age at drug initiation was 82 years; for pergolide it was 1.8 mg, 32 months, and 83 years; for pramipexole 2.7 mg, 14 months, and 83 years, and for ropiniro le 10.6 mg, 11 months, and 83 years. CONCLUSION: This study demonstrated that therapeutic dosages of dopamine ag onists were well tolerated by 46% of very elderly patients who received a t rial of an agonist. These results indicate that dopamine receptor agonist t herapeutic trials are warranted in selected very elderly patients.