Antiparkinsonian agents with strong anticholinergic activity (such as benztropine and trihexyphenidyl) are not recommended in older adults for:

• A. They are preferred for prevention of extrapyramidal symptoms from antipsychotics.
• B. They are essential first-line for Parkinson disease in older adults.
• C. They are not recommended for prevention or treatment of EPS due to antipsychotics.
• D. They have strong efficacy and minimal side effects in older adults.

Answer: (C)

In older adults, anticholinergic medications used to counteract extrapyramidal symptoms from antipsychotics are discouraged because these drugs raise the risk of cognitive impairment and delirium, and they contribute to confusion, falls, constipation, urinary retention, and other anticholinergic burdens. Benztropine and trihexyphenidyl can worsen mental status in the elderly, making them inappropriate for prevention or treatment of EPS in this population. That’s why the correct choice states they are not recommended for EPS prevention or treatment due to antipsychotics. The other ideas—being preferred for EPS prevention, being essential first-line for Parkinson disease in older adults, or having strong efficacy with minimal side effects in this group—do not align with the known risks and guideline guidance for older adults.