Parkinson disease and dementia with Lewy bodies Quiz: Ace Your Exams

A 78-year-old man with Parkinson disease presents to the clinic for follow-up. The patient started on carbidopa-levodopa two years ago, and his tremor has been well-controlled until about six months ago. Now, the patient notices the return of the tremor and increased clumsiness about thirty minutes to an hour before the next dose is due. The patient also notes feeling fidgety when he takes his medication. Past medical history is significant for hypertension, for which the patient takes lisinopril. Temperature is 37.0°C (98.6°F), pulse is 80/min, respirations are 14/min, and blood pressure is 128/85 mmHg. On exam, the patient is alert but has a flattened affect and slow movements. There is a pill-rolling tremor of the right hand at rest and cogwheel rigidity of the right elbow. The patient is due for a dose of medication. In addition to supportive care, including caregiver counseling and therapy services, which of the following additional interventions is most likely indicated for the management of this patient’s symptoms?