be useful in patients with early PD but have only

modest symptomatic benefit as monotherapy. (See 

'MAO B inhibitors' below.)
●Anticholinergic drugs are most useful as
monotherapy in patients under 70 years of age with
1
disturbing tremor who do not have significant
bradykinesia or gait disturbance. They also may be
useful in patients with more advanced disease who
have persistent tremor despite treatment with
levodopa or dopamine agonists. Their use in older or
demented individuals and those without tremor is
strongly discouraged. (See 'Anticholinergics' below.)
●Amantadine is a relatively weak antiparkinsonian
drug with low toxicity that is most useful in treating
younger patients with early or mild PD and perhaps
later when dyskinesia becomes problematic.
However, toxic side effects are more likely in older
patients. (See 'Amantadine' below.)
●Low-dose estrogen may be helpful as adjunctive
therapy in postmenopausal women (See 'Estrogen'
 below.).
There are exceptions to these general rules, and all
treatments for PD should be individualized.
Practitioners should always try to find the lowest but
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still effective dose of dopaminergic medication, either
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