An abnormal MMSE suggests cognitive impairment but is not diagnostic of dementia. Conversely, a normal test does not exclude cognitive impairment. Until recently, all treatment of PD was symptomatic. This suggested that selegiline may be able to slow the progression of PD, possibly by reducing the generation of toxic free radicals. This symptomatic effect remains the focus of unresolved debate.
Some clinicians think it is reasonable to continue selegiline once it has been started.
If selegiline is later shown not to have a neuroprotective effect, little harm will have been done. If, on the other hand, the drug is later shown to have such an effect, patients who did not receive it may have needlessly suffered a greater loss of neurons than those who did. The choice of drugs used in the treatment of PD is determined in part by the relative chronologic and biologic age of the patient. If its effect wanes and other antiparkinsonian medications are added, amantadine should be discontinued to avoid unnecessary polypharmacy. Gradual withdrawal is recommended to prevent acute exacerbation of parkinsonian symptoms.