What medication may be an appropriate first-line therapy for patients over age 70, especially those with dementia?
Levodopa may be preferable for patients over age 70, especially those with dementia. These patients are at higher risk for side effects (e.g., confusion, hallucinations, hypotension, nausea and vomiting) from dopamine agonists which are considered an appropriate first-line therapy for older patients who have normal physical and cognitive function. On the other hand, these patients are at higher risk for side effects from dopamine agonists, including confusion, hallucinations, hypotension, nausea and vomiting, and daytime sedation. Anticholinergic medications should be used with caution in patients with dementia and the very old because they may provoke acute confusional states or cause or contribute to cognitive dysfunction. • When should the physician determine whether consultation from a neurologist or psychiatrist is appropriate? When change in neurological status or a sustained change in mental status occurs, the physician should evaluate the situation and determine whether consult
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