Which Parkinson disease medication is commonly used as mono-therapy in younger patients?

• A. Carbidopa/Levodopa
• B. Selegiline
• C. Amantadine
• D. Pramipexole/Ropinirole

Answer: (D)

In younger patients with Parkinson disease, starting treatment with a dopamine agonist is a common approach because it provides symptomatic relief while delaying the need for levodopa, which is associated with motor complications over time. Dopamine agonists like pramipexole and ropinirole directly stimulate dopamine receptors in the brain, offering control of stiffness, slowness, and tremor without the same risk of dyskinesias that comes with long-term levodopa use. This makes them a preferred initial, single-agent therapy in younger individuals who want to postpone levodopa exposure.

Other options fit different roles. Levodopa/carbidopa is highly effective but tends to lead to troublesome dyskinesias and motor fluctuations with long-term use, so it’s often reserved for when symptoms become more advanced or when other therapies are insufficient. Selegiline, an MAO-B inhibitor, can be used in early disease but is less commonly chosen as first-line monotherapy in younger patients compared to dopamine agonists. Amantadine can help with mild symptoms or dyskinesias but is not typically the primary monotherapy in younger patients.