The clinical findings as well as the follow-up of 52 patients with progressive Parkinsonism were analyzed and the following results obtained: The reasons for the clinical progression of the disease were most often acute secondary illnesses not involving the CNS, Parkinsonism-independent CNS lesions ("Parkinson plus"), the absolute as well as relative L-DOPA overdose and, lastly but significantly, the effects and side-effects of too many prescribed drugs. Our findings resulted in the following therapeutic recommendations: A monotherapy should be used for as long as possible with slowly increasing doses up to the threshold of tolerance. Only if necessary should alternative drugs or a combination of not more than two drugs be used. Parkinsonism progresses even with the present best therapy. So far, it was only been possible to mitigate this progress, but not to prevent it. In the late stage of the disease it is more appropriate to accept some remaining symptoms than to risk an overdose or polypharmacy with its attendant problems.

Amantadine↗

PubMedDate not supplied

["Abnormal" neurologic findings in the "healthy" elderly].

Neuropathological changes and clinical neurological findings of the nervous system of healthy, old people (more than 80 years old) are referenced according to the literature. In addition, the results of a clinical neurological examination of 86 healthy senior citizens (average age: 83.6 years) are demonstrated. The respective findings are summarized in a table according to their frequency. The involution of the human nervous system with age results neuropathologically and clinically-neurologically in damage to the frontal lobe (disinhibition of archaic reflexes), the extrapyramidal system (Parkinsonian walking pattern), the posterior tract of the spine (unsteadiness of walking), and the peripheral nervous system (e.g. loss of the achilles tendon reflex). The Parkinsonian-like walking pattern of the healthy old-aged human is thought to be a disinhibition of an archaic pattern of posture and movement. Brief suggestions for differential diagnosis and therapy are presented.

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