Page 524 - Basic _ Clinical Pharmacology ( PDFDrive )

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C ASE STUD Y ANSWER

The history is suggestive of parkinsonism, but the incon- or precipitate behavioral and cognitive disturbances. Sleep
spicuous tremor and early cognitive changes raise the possi- attacks may occur spontaneously but are especially noted in
bility of atypical parkinsonism rather than classic Parkinson’s patients receiving dopamine agonists. The patient has also
disease. The prognosis of these disorders is worse than that developed punding, which is a recognized adverse effect of
of classic Parkinson’s disease. Given the cognitive changes dopaminergic medication. Surgical treatment (deep brain
and his age, the use of a dopamine agonist was unwise, as stimulation) is contraindicated in patients with cognitive
these agents are more likely than levodopa to exacerbate changes or atypical parkinsonism.