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Sinemet CR in Elderly

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My 80-year-old husband was diagnosed with PD 15 months ago, the akinetic-rigid syndrome type.  He had been very physically active up until a few years of this diagnosis with his activity slowly becoming limited by his sense of imbalance.  In retrospect, we realize he had these imbalance symptoms at least five years prior to diagnosis.  He has had autonomic symptoms too -- blood pressure swings from over 210/110 to 74/48; urinary frequency, urgency and incomplete bladder emptying (helped some by TURP done 9 months ago); gastrointestinal issues (constipation to severe diarrhea); REM sleep issues (physically acting out dreams); etc.  He also has a small acoustic neuroma (4.7mm).  Our question is that his neuro really doesn't seem to have a clue what is going on and we are unsure as to how to get him the oversight he needs.  He started him on Sinemet IR, added Ropinirole, then added Sinemet CR, then added Amantadine (plus a couple other things that I can't remember names of but that he no longer takes due to side effects -- oh, one was Xadago).  He doses every six hours but usually suffers restless legs before next dose and is fairly rapidly continuing to get worse, now requiring a lot of assistance and use of a walker/rollator.  Fortunately his cognitive ability is still good. He has fallen several times (once breaking his leg) and passed out while sitting involved in a conversation.  We've read that Sinemet CR is not recommended for the elderly and we think perhaps the Sinemet, which has never particularly restored him to better functioning, could be causing some of the hypotension (he was being treated for hypertension prior to taking Sinemet).  I know this is a lot to put out there, but we are desperate for some guidance from someone like you who may recognize some red flags in all this.  We've heard of MSA and asked his neuro if that could be what's going on but he says no, in spite of doing nothing to figure out what IS going on.  And, sadly, there is NO medical coordination of his many symptoms -- we see different specialists who zero in on their specialty only. We live in a small rural community and have to travel 50 miles to the neuro.  We're not asking you to diagnosis from afar, but would so appreciate your recommendations for how we can get the medical care he needs.  Thank you so much for any direction you can offer.

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If the diagnosis is truly 15 months ago one would have to wonder about MSA or another syndrome.

The autonomic issues can often be addressed by simplifying regimens to Sinemet only (get rid of agonists and other drugs) and use low doses more frequently.  In some cases adding midodrine, florinef or Northera could be helpful.

These are of course a few suggestions.  Finally, using a PT and also an OT and getting assisstive devices and strategies can prevent fractures and falls....

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