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To: Brian Elliot It is my opinion that memory problems are automatically assumed to be Alhzheimer's in senior citizens. I think more and more will be changed to PD and not because of any increase in dementia amoung PD patients, but because when we are not on the proper medication, our mential facilities decrease. When I am properly medicated not only do my motor functions work reasonably well, but my mental functions are also working well. I am able to argue a point, play games requireing concentration, etc. Remove me from my meds for 2 or 3 hours and not only are my motor functions slowed but so are my mental functions. It takes all my mental power to motivate me to get out of an easy chair. I am so consumed with my physical and mental state that my ability to communicate is severely impaired. My talk may be slow and monitone, my hearing misses most of the first few words spoken and I just automatically respond with "What?" Mentally I am a wreak. Now when I was first diagnosed, I was slow physically, but I also think I was slowing mentally. My diagnosis was based on movement not on mental agility. As I talk to more senior citizen who have been recently diagnosed, they tell me about how the medications not only put Spring in their walk, it made them more extraverted. Undermedication of PD in our senior citizen, to me, is a crime. It is robbing them of everything they have lived for. Now I know there is always concern for complications with the aging process. Raising the medicine level can cause complications. For the rest of us, my opinion is to medicate at or near the optimal. Recent reports are saying that the amount of levodopa consumed is not a predictor of start of ON/OFF flucations. What is being reported is potentail atrophy to the brain from long periods of undermedicaton and overmedication. If a researcher would evaluate the MRI scans of pallidotomy patients and try to correlate brain atrophy to age and medication levels I think much might be learned. For thos of you who are proponents of undemedication on the assumption that this will delay ON/OFF problems, here are some things to think about: 1. Are you totally engrossed in your PD that it is the only thing you talk about or want to talk about? 2. Do you find yourself complaining about slowness and how difficult every is. 3. Do people avoid you leaving only other undermedicated patents to talk to and they are boring? Well, this is only my optinion and I am not a doctor of anything. But the next neurologist who tells me they tell their patients it is better to be undermedicated because it will delay the ON/OFF problems, I will suggest their patients do the same with his/her fee. That is my pillbox for the day. By the way, over medication does the same as undermedication. Regards, Alan Bonander ([log in to unmask])