A 72-Year-Old Man with a History of Parkinson Disease Comes

A 72-year-old man with a history of Parkinson disease comes to the office for follow-up.  The patient has been taking levodopa/carbidopa since being diagnosed 5 years ago, and has required increasing doses of medication to control his symptoms.  He is currently on a maximum dose, but for the past several months has experienced bothersome motor fluctuations.  The patient also reports worsening stiffness and difficulty moving before his next scheduled dose, which improves after taking the medication.  Entacapone is added to his treatment regimen.  This drug most likely improves this patient's symptoms by which of the following mechanisms?

A) Decreasing peripheral levodopa degradation
B) Directly stimulating dopamine receptors
C) Enhancing the effect of endogenous dopamine
D) Inhibiting central muscarinic receptors
E) Inhibiting centrally-active acetylcholinesterase

Correct Answer:

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