Background: Parkinson's disease is the second most common neurodegenerative disorder for which old age is the best known risk. The proportion of elderly in the world is increasing, resulting in larger pool of people at risk for Parkinson's disease. Several other neurodegenerative disorders also produce Parkinson syndrome. Distinguishing between those variants is only possible with pathological examination of brain. No autopsy confirmed study of 80 years and older onset in parkinsonism cases has been reported. Clinical features of different PS variants, response to treatment and progression of disease in this age group remain to be determined. Methods: Patients evaluated at Movement Disorders Clinic Saskatchewan are offered a choice of autopsy at no cost. The brain is studied by board certified neuropathologist. Results: Thirty cases with clinical diagnosis of parkinsonism (onset >= 80 years) came to autopsy. Twenty-one (70%) had Parkinson's disease alone and two (6.7%) had an additional movement disorder. The progression of Parkinson's disease was accelerated, and dementia evolved earlier than reported in the younger onset cases. Most cases that tolerated an adequate dose improved on levodopa. Conclusion: Parkinson's disease is the most common variant in the octogenarian population. Most patients benefit from levodopa, and should be tried on the drug when diagnosis of parkinsonism is made. (C) 2017 The Authors. Published by Elsevier Ltd.