Latt Mark Dominic, Lewis Simon, Zekry Olfat, Fung Victor S C
Geriatric Medicine Department, University of Sydney, Royal Prince Alfred Hospital, KGV Level 7, Missenden Road, Camperdown, NSW, 2050, Australia.
Parkinson's Disease Research Clinic, Brain and Mind Centre, University of Sydney, Sydney, NSW, Australia.
Drugs Aging. 2019 Mar;36(3):189-202. doi: 10.1007/s40266-018-0629-0.
Dopamine agonists (DAs) are frequently used in the management of Parkinson's disease (PD), a complex multisystem disorder influenced substantially by age-related factors. Over 80% of PD patients present after age 60 years and may have clinical features exacerbated by age-related comorbidities or decline in physiological compensatory mechanisms. Pharmacotherapy for motor symptoms in older persons is more likely to involve exclusive use of levodopa combined with a peripheral decarboxylase inhibitor throughout the course of the illness. Non-ergot DAs, such as pramipexole, rotigotine and ropinirole, may be used as de novo monotherapy for the control of motor symptoms in older persons, although they are less efficacious than levodopa therapy. DAs may also be considered as adjunct therapy in older persons when motor symptoms are no longer adequately controlled by levodopa or when motor fluctuations and dyskinesia appear. DAs may be used cautiously in older persons with cognitive impairment and orthostatic hypotension but should be avoided when there is a history or risk of psychosis or impulse control disorders.
多巴胺激动剂（DAs）常用于帕金森病（PD）的治疗，帕金森病是一种复杂的多系统疾病，受年龄相关因素的影响很大。超过80%的帕金森病患者在60岁以后发病，可能具有因年龄相关合并症或生理代偿机制下降而加重的临床特征。老年人运动症状的药物治疗在病程中更可能涉及全程单独使用左旋多巴联合外周脱羧酶抑制剂。非麦角类多巴胺激动剂，如普拉克索、罗替戈汀和罗匹尼罗，可作为老年人运动症状控制的初始单药治疗，尽管其疗效不如左旋多巴治疗。当运动症状不再能被左旋多巴充分控制或出现运动波动和异动症时，多巴胺激动剂也可被视为老年人的辅助治疗。对于有认知障碍和体位性低血压的老年人，多巴胺激动剂可谨慎使用，但有精神病或冲动控制障碍病史或风险时应避免使用。
