Parkinson Disease — Clinical

A 62-year-old man with Parkinson disease for 8 years presents with motor fluctuations and dyskinesias despite optimal levodopa dosing. Regarding the motor complications of Parkinson disease, all of the following statements are true EXCEPT:

A 68-year-old woman from Mumbai with Parkinson disease of 8 years' duration, currently on levodopa 500 mg/day, presents with involuntary writhing movements of her limbs and trunk that appear 2–3 hours after each dose of medication and resolve before the next dose. She also reports episodes of sudden freezing while walking, particularly when turning or entering doorways. Which of the following is the most appropriate next step in management?

A 62-year-old man with a 5-year history of Parkinson disease is being evaluated for motor complications. Which clinical feature best distinguishes idiopathic Parkinson disease from atypical parkinsonian syndromes (progressive supranuclear palsy and multiple system atrophy)?

A 62-year-old man from Delhi presents with a 3-year history of progressive slowness of movement and tremor in his right hand at rest. On examination, he has a masked facies, cogwheel rigidity in both upper limbs, and a shuffling gait with reduced arm swing. His Mini-Cog score is 4/5. He is currently on no medications. Which of the following is the most appropriate first-line pharmacological agent to initiate in this patient?

A 58-year-old woman with Parkinson disease of 8 years' duration, currently on pramipexole 1.5 mg TID and levodopa 250 mg QID, develops motor fluctuations ('on-off' phenomena) and peak-dose dyskinesias. Which agent should be added to reduce dyskinesias and smooth motor response?