American Board of Internal Medicine (ABIM) Certification Practice Exam

For younger patients with Parkinson's disease, what is recommended as first-line therapy?

1. Levodopa

2. Dopamine agonists

3. Monoamine oxidase inhibitors

4. Catechol-O-methyltransferase inhibitors

The correct answer is: Dopamine agonists

For younger patients with Parkinson's disease, dopamine agonists are recommended as first-line therapy due to a few key reasons. Dopamine agonists, such as pramipexole and ropinirole, directly stimulate dopamine receptors in the brain. This is particularly beneficial for younger patients who may experience a better long-term response to treatment and may develop motor fluctuations or dyskinesia later on if treated initially with levodopa. Levodopa, while effective and often considered a potent treatment for Parkinson's disease, is generally reserved for older patients or those with more severe symptoms at the onset of the disease. Starting younger patients on levodopa can lead to the early development of motor complications, such as wearing-off phenomena and involuntary movements, which are often linked to long-term use. Monoamine oxidase inhibitors and catechol-O-methyltransferase inhibitors are generally not used as first-line treatments for younger patients with early Parkinson's disease. These medications can be beneficial, but they are typically introduced later in the treatment regimen as adjunctive therapies rather than primary treatment options. Therefore, dopamine agonists are favored as they help manage symptoms while minimizing the risks of long-term treatment complications associated with levodopa.