Parkinson’s 101:  Introduction to PD

With feedback from others who have been diagnosed with Parkinson’s Disease.

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The information contained in this publication is provided for informational and educational purposes only and should not be construed to be a diagnosis, treatment, regimen, or any other healthcare advice or instruction. The readers should seek his or her own medical or other professional advice, which this publication is not intended to replace or supplement. PRC disclaims any responsibility and liability of any kind in connection with reader’s use of the information contained herein.

To print a copy of PD101 to keep and share, download here

parky_rght_best-defringed1Hello, this is Parky, from the Parkinson’s Resource Center here in the Inland Northwest.

Ok, so who am I? Who is Parky anyway? The co-founder of the Parkinson’s Resource Center or the PRC, Ed Ewell, went on a   trip to the Antarctica. While there, he saw Emperor Penguins, after watching them said “they move like some of those with Parkinson’s”.

From that point forward I became the “Mascot” for the PRC. You will see me later and hopefully you will know that you are not alone.

You received this book today because you have been diagnosed with Parkinson’s Disease. The first thing we want to let you know is that you are NOT alone, and we mean that in many ways.

  • You have the support of the doctor that diagnosed you and their team.
  • You have the support of the Parkinson’s Resource Center and its activities and programs
  • This quick guide, PD:101
  • And many other people with Parkinson’s in the Inland Northwest who also have been diagnosed with Parkinson’s Disease.

We want to let you know that we are here for you as a resource…here are some things that we think you should know.

  • From here on out in the PD:101, Parkinson’s Disease =PD, to make things a bit easier and so we can spend more of our energy on helping you.
  • There are 60,000 adults diagnosed with Parkinson’s Disease each year, the average age of diagnosis is 58 years old. But of those diagnosed with PD, approximately 10% are between the ages of 21 and 40, usually considered Young Onset PD.
  • You are not alone, in the Spokane and Inland Northwest, there are over 5,000 people who have also been diagnosed with PD. You are not alone. Because you now have a group of people who understand much of what you are experiencing and that is always a plus!
  • Getting diagnosed with anything is sometimes scary, PD is not a fatal   disease. You will not die from PD. There are things you need to know on how to live a long and active life with PD…and this PD:101 is one of the tools we hope will help you do so.

Some basic information, we will start here…please remember that the information you find within is not a replacement for your   physician. They are your first line of help but we will be here to support you. If you are reading this and have questions, write them down, or a family member or friend; on our question sheet so that you can discuss them the next time you see your PD doctor.

(The Parkinson’s Resource Center (PRC) in Spokane has several Facebook pages where those with PD can share their experiences, find   others with PD. Recently we asked our Facebook followers ”When you were first diagnosed, what did you want to know?” Combining these answers with results from a survey conducted in 2011, we will attempt to answer yours and their question in the following pages. The feedback that we received can be seen in the upper right hand corner of the pages throughout the PD:101 Guide.)


“My doctor diagnosed me with Parkinson’s disease, but it was a bit of a shock. I don’t know that I heard everything the doctor had to say about it.

What is Parkinson’s disease?”


Parkinson’s disease (PD) is classified under an umbrella of conditions called movement disorders. Just as the name implies, movement disorders are conditions that affect one’s ability to move. Specifically in PD, the cells in a person’s brain that produce dopamine, a chemical required for movement, slowly deteriorate.

PD is thus called a neurodegenerative disorder, which means that certain types of cells in the brain die over time. As these dopamine-making cells are lost, PD symptoms begin to show, and over time the disease progresses and worsens. Experts that study PD have found that about 80% of dopamine-making cells are lost by the time PD is diagnosed.

How is PD diagnosed?

So far, there is no test that a doctor can give you to see if you have PD. Unlike other conditions, such as diabetes, there is nothing in your blood or other tissues that reveals whether you have PD or not. There are many research studies that are currently trying to tackle this issue and find biomarkers, or substances in the body that could be measured to test for PD. Until that happens, the diagnosis of PD is based only on the symptoms someone has.

Physicians who diagnose PD look for the main motor signs of PD (tremor, bradykinesia, rigidity, and postural instability). Someone doesn’t need to have all of these to have PD, but usually at least two of these signs are present. Other signs that indicate PD are that the symptoms started on one side of the body or are worse on one side of the body and the symptoms respond well to PD medication.

By examining your symptoms, your doctor will rule out other conditions that could mimic PD. For example, there is another disorder called Essential Tremor that can be mistaken for PD. This is a condition in which one has tremors/shakes. The main difference between PD and Essential Tremor, however, is that the Essential Tremor happens during an action and not at rest. People with Essential Tremor experience shakiness when they reach for objects or write, unlike people with PD who tend to have a tremor when their limb is resting.

What are the Symptoms of PD?

PD varies from person to person and is as unique as those it affects. It is important to know that PD looks different for everyone. In fact, there are many people who you would look at and never know they have the condition. Although tremor is a common symptom, you may be surprised to know that up to 30-40% of people with PD never have a noticeable tremor. However, there are four common symptoms of PD that affect movement. There are also several symptoms that people with PD experience that aren’t related to their movement at all.

 “Can I have more than one type of symptom?”

What are the Motor (Movement) Symptoms?

There are four common motor, or movement symptoms of PD:
  1. Tremor (shaking): People with PD may notice a tremor, most commonly in their hand(s). It usually starts on one side of the body and eventually affects both sides. It may be in their hand, feet, arms, legs, or even head. The tremor caused by PD is called a rest tremor, because it happens when the body part is resting. For example, a person with PD may notice their hand shaking when it is sitting on their lap, but when they reach for a cup of coffee, the tremor stops.
  2. Rigidity (stiffness): Nearly everyone with PD has some degree of rigidity, or muscle stiffness. The rigidity may be worse on one side of the body, and it may make movement more difficult. Some people who are diagnosed with PD will have been treated for various other muscle issues, like shoulder problems, which were caused by this stiffness
  3. Bradykinesia (slowness of movement): People with PD will notice that their movement is slowed, especially when they are starting a motion. For example, it may take a bit of extra effort to start walking. Movement that was previously automatic can become something that a person with PD has to consciously think about.
  4. Postural Instability (balance problems): Oftentimes a person with PD may have difficulty with balance. They may lean to one side or the other, or stoop forward. This can increase the risk of taking a fall. Many doctors will do a test to check for balance problems in PD. They will stand behind the patient and suddenly pull the patient backwards to see if the person is able to maintain balance.

What are the Non-Motor (Non-Movement) Symptoms?

Aside from its effects on movement, PD may cause other noticeable symptoms. Below are some of the signs of PD that aren’t motor symptoms. These are collectively   referred to as the non-motor symptoms or PD. Certainly everyone with PD does not have all of these, or any for that matter. But it is important to recognize PD’s role in each of these areas. These symptoms will be discussed in depth in the “Treatment” section.

  • Constipation
  • Bladder Issues
  • Sleep Disturbances
  • Depression/Anxiety
  • Drooling
  • Difficulty Swallowing
  • Hallucinations/Psychosis
  • Difficulty Thinking
  • Dizziness / Low Blood Pressure
  • Sweating
  • Problems with Vision or Dry Eyes
  • Problems with Sexuality

My doctor says I have Parkinsonism?

Isn’t that the same thing as Parkinson’s disease?

Parkinsonism can be thought of as an umbrella term, encompassing movement disorders that are similar to PD in their symptoms. Everyone who has PD can also be classified as having Parkinsonism, but not everyone with Parkinsonism has PD.

For example, if someone with suspected PD begins to have lots of balance problems and falls early on (something that is not usually seen in PD), their doctor may begin to suspect an atypical form of PD, also called a Parkinson’s Plus syndrome. In Parkinson’s Plus syndromes, there are additional symptoms beyond the four common motor signs of PD. Some examples of Parkinson’s Plus syndromes are Multiple System Atrophy (MSA), Progressive Supranuclear Palsy (PSP), Corticobasal Degeneration (CBD), and Dementia with Lewy Bodies (DLB).

Below is a list of signs that would make a healthcare provider more suspicious of a Parkinson’s Plus syndrome:

  • Minimal or less-than-expected response to medications for PD
  • Problems with thinking/memory at diagnosis or soon after
  • Early balance problems and falls
  • Early problems with “freezing”
  • Hallucinations and/or psychosis early on
  • Difficulty with eye movements
  • Low blood pressure early after diagnosis
  • Bladder incontinence
  • Symptoms equal on both sides of the body

What Causes PD? How did I get it? Did I do something to cause this?

The exact cause of PD is unknown at this time. We don’t yet know why brain cells stop making dopamine. Most likely, the development of PD is influenced by many factors, including your environment, genetic make-up, family history, age, and ethnicity, among others.

Risk Factors

Environment. Living in a rural area may increase the risk for developing PD. Research has shown that exposure to pesticides and herbicides may increase the risk of PD, and people who drink well water may be at greater risk. Additionally, having a head injury increases the risk that PD will develop.

Genetics.  Most people with PD did not inherit the disease in their genes. Rather, it is thought that some people may be more vulnerable to developing PD, but their environment tips the scale one way or the other. The one exception to this rule is in early-onset PD. Patients who are diagnosed with PD before the age of 50 are considered to have early-onset or young-onset PD. It seems that genetics may play a bigger role in this form of PD.

Age.  Approximately 10% of PD cases are the young-onset type. The majority of people diagnosed with PD are over the age of 50, so aging increases the risk of developing PD.

Gender. PD is slightly more common in men than women.

Ethnicity. Caucasians have a higher rate of PD than people of African or Asian descent.

Medication. Certain types of medications may cause drug-induced Parkinsonism. A number of medications work by blocking dopamine in the brain. These medications have the potential to cause symptoms that are very similar to PD, although one difference is that the symptoms are usually on both sides of the body equally. Luckily, most cases of drug-induced Parkinsonism resolve once that particular medication is stopped. Medications that may cause drug-induced Parkinsonism are listed in the following table. If you have been taking one of these medications and experience the symptoms of PD, ask your doctor if there is a better alternative for you. Never stop a medication on your own without consulting your doctor or pharmacist. *Medication table found on page 13.

Medication Type Brand Name Generic Name

Antipsychotic

Abilify Aripiprazole
Geodon Ziprasidone
Haldol Haloperidol
Invega Paliperidone
Prolixin Fluphenazine
Risperdal Risperidone
Stelazine Trifluoperazine
Thorazine Chlorpromazine
Trilafon Perphenazine
Zyprexa Olanzapine

Anti-Nausea

Compazine Prochlorperazine
Phenergan Promethazine
Reglan Metoclopramide

I’ve been diagnosed with Parkinson’s Disease…what can I expect now?

 PD is a progressive disease, meaning that it will worsen with time.

Everyone’s symptoms advance at a different rate. Some people live 30 or 40 years with PD and still maintain a great deal of independence. Others have more severe symptoms and a higher level of disability within 10 years. In fact, many people have mild symptoms of PD long before they are actually diagnosed with the condition. This makes it hard to predict what any one individual’s progression will look like.

As PD advances, the motor symptoms generally worsen. Many people with PD begin to experience freezing episodes, in which their feet feel glued to the floor. Walking and turning become progressively more difficult and dexterity is lost. Speech and swallowing can become more challenging and difficulty with memory or thinking may occur in advanced PD.

Luckily, there are things you can do to fight this progression. Maintaining your overall health and tackling PD head-on with medications and non-drug therapies like exercise can greatly improve your wellness. Taking a proactive approach early on can ward off complications later.

What can I expect as treatment for PD and how long will it take for me to see the difference?

So far, there is no cure for PD. We hope that a neuroprotective therapy will be found, which would stop PD from progressing and save the dopamine-making cells in the brain. Such a therapy would essentially be a cure for PD; it could be given to people very early in the disease (or even to people who are at high risk for PD) to stop it in its tracks. Until that happens, we have to rely on symptomatic therapy, which is therapy that only targets and relieves the symptoms of PD and not the underlying disease itself.

For more detailed information about each medication, please refer to the following 6 pages.

Always keep a list of your medications and give it to each healthcare professional you see (see Medication List handout provided in this

Carbidopa/Levodopa (Sinemet, Sinemet CR):

Levodopa is considered the gold standard for treating PD, and it greatly eases motor symptoms. Levodopa is always given with carbidopa, which can be thought of as a shuttle to get the levodopa up to the brain, where it is changed into dopamine.

Even with levodopa, there are some complications associated with taking it. With long-term use, many people who take levodopa may develop some degree of dyskinesia (involuntary movement) and/or motor fluctuations (medication wears off between doses and symptoms come back, “on/off” effect). Dyskinesia usually happens when levodopa is having its peak effect. Luckily, for most people dyskinesia is not bothersome. It usually affects the head, neck, and trunk. The motor fluctuations that can happen while taking levodopa can be very frustrating. When someone with PD first begins to take levodopa, they might only have to take it two or three times a day, and if they miss a dose they don’t notice much of anything. With time, however, the levodopa doesn’t seem to last as long and many people will notice that it “wears off” and their symptoms return before their next dose is due. Another thing that can happen is called an “on/off phenomenon.” For instance, you may take your levodopa and normally notice an effect within 30 minutes to an hour, but for some reason it sporadically doesn’t seem to work as well. Or randomly after you take it and it is having an effect, you feel yourself turning “off.” These side effects can be managed by taking levodopa more often or using additional medications as add-on therapy.

Some people with PD try to avoid taking levodopa for as long as possible because they are afraid of these side effects, or they have heard that levodopa eventually stops working. This is a myth. Levodopa never stops working; rather it is the PD itself that is progressing. The dramatic benefit that levodopa provides should never be withheld because of fear of side effects. That said, many healthcare practitioners will use other medications before levodopa in an effort to delay the use of levodopa and its side effects.

Generic Name Brand Name Available Dosages Possible Side Effects Role in PD Therapy Special Notes
Levodopa
Carbidopa/levodopa immediate-release Sinemet® 10/100mg tab Nausea, low blood pressure/dizziness, dyskinesia (involuntary muscle movement) First-line therapy or add-on therapy Absorption may be decreased when taken with a high protein meal in protein-sensitive patients.
25/100mg tab
25/250mg tab
Carbidopa/levodopa controlled-release Sinemet CR® 25/100mg tab Nausea, low blood pressure/dizziness, dyskinesia First-line therapy or add-on therapy Tablets may be split once. Absorption may be decreased when taken with a high protein meal in protein-sensitive patients.
50/200mg tab
Carbidopa/levodopa oral-disintegrating Parcopa® 10/100mg tab Nausea, low blood pressure/dizziness, dyskinesia First-line therapy or add-on therapy Absorption may be decreased when taken with a high protein meal in protein-sensitive patients. Often used in people with swallowing difficulty.
25/100mg tab
25/250mg tab
Carbidopa Lodosyn® 25mg tab Well tolerated Nausea due to levodopa Only used in combination with levodopa.
Carbidopa/levodopa/entacapone Stalevo® 12.5/50/200mg tab Nausea, dizziness, dyskinesia, diarrhea, urine/body fluids discolored (orange) Levodopa wearing off Absorption may be decreased when taken with a high protein meal in protein-sensitive patients.
18.75/75/200mg tab
25/100/200mg tab
31.25 200/125mg tab
37.5/150/200mg tab
50/200/200mg tab

Dopamine Agonists:

Dopamine agonists can be thought of as impersonators of dopamine. They enter the brain and cause the same actions as naturally-produced dopamine. The currently available dopamine agonists pramipexole (Mirapex, Mirapex ER) and ropinirole (Requip, Requip XL) often work well in early PD, but eventually nearly all patients will need levodopa/carbidopa (Sinemet®) therapy. When someone is taking levodopa/carbidopa, the dopamine agonists can also be used as add-on therapy to gain additional control of movement symptoms (e.g., tremor, rigidity).

People taking dopamine agonists should be aware of their side effects. Pramipexole and ropinirole can cause quite a bit of sleepiness. They have even been associated with so-called “sleep attacks,” episodes in which people fell asleep randomly (some even while driving). If you are taking a dopamine agonist and find yourself falling asleep when you normally wouldn’t, stop driving and contact your doctor. Dopamine agonists can also cause impulse control disorders, which are problems in which one feels compelled to participate in an activity. Gambling, excessive shopping, binge eating, and inappropriate sexual behavior have all been reported in people taking dopamine agonists.

Generic Name Brand Name Available Dosages Possible Side Effects Role in PD Therapy Special Notes
Dopamine Agonists
Pramipexole immediate-release Mirapex® 0.125mg tab Nausea, dizziness, sleepiness and sleep attacks, hallucinations, leg swelling/water retention, compulsive behavior First-line therapy or add-on to levodopa Alert healthcare provider if patient beings falling asleep during activities.
0.25mg tab Also used for Restless Legs Syndrome.
0.5mg tab
1mg tab
1.5mg tab
Pramipexole extended-release Mirapex ER® 0.375mg tab Nausea, dizziness, sleepiness and sleep attacks, hallucinations, leg swelling/water retention, compulsive behavior First-line therapy or add-on to levodopa Alert healthcare provider if patient beings falling asleep during activities.
0.75mg tab
1.5mg tab
3mg tab
4.5mg tab
Ropinirole immediate-release Requip® 0.25mg tab Nausea, dizziness, sleepiness and sleep attacks, hallucinations, leg swelling/water retention, compulsive behavior First-line therapy or add-on to levodopa Alert healthcare provider if patient beings falling asleep during activities.
0.5mg tab Also used for Restless Legs Syndrome.
1mg tab
2mg tab
3mg tab
4mg tab
5mg tab
Ropinirole extended-release Requip XL® 2mg tab Nausea, dizziness, sleepiness and sleep attacks, hallucinations, leg swelling/water retention, compulsive behavior First-line therapy or add-on to levodopa Alert healthcare provider if patient beings falling asleep during activities.
4mg tab
6mg tab
8mg tab
12mg tab
Apomorphine Apokyn® 20mg/2mL vial Nausea, dizziness, sleepiness, flushing, yawning “Off” episodes/Freezing Must take anti-nausea medication Tigan® for at least 3 days prior to starting apomorphine.
30mg/3mL vial

COMT Inhibitors:

Catechol-o-methyltransferase (COMT) is an enzyme that can inactivate levodopa before it has time to get to the brain and be transformed into dopamine. COMT inhibitors stop this enzyme, allowing more levodopa to enter the brain. This class of medications is always used in conjunction with levodopa, generally for people experiencing wearing off between levodopa doses. The most commonly used COMT inhibitor is entacapone (Comtan), which is also combined in a tablet with carbidopa/levodopa (Stalevo). Another COMT inhibitor that is less commonly used is tolcapone (Tasmar).

Generic Name Brand Name Available Dosages Possible Side Effects Role in PD Therapy Special Notes
COMT inhibitors  
Entacapone Comtan® 200mg tab Diarrhea, bodily fluids discolored (orange) Levodopa wearing off Used only in combination with levodopa and given with every levodopa dose. May need to reduce levodopa dose when starting entacapone.
Tolcapone Tasmar® 100mg tab Diarrhea, liver problems Levodopa wearing off Rarely used due to risk of liver problems.

MAO-B Inhibitors:

In our brains, dopamine is broken down by the enzyme monoamine oxidase type B (MAO-B). MAO-B inhibitors essentially prevent this degradation of dopamine, allowing more dopamine to remain in the brain and be used. The currently available MAO-B inhibitors are rasagiline (Azilect) and selegiline (Eldepryl, Zelapar). While these medications provide modest PD symptom relief, they can be used as first-line therapy or add-on therapy to levodopa.

Generic Name Brand Name Available Dosages Possible Side Effects Role in PD Therapy Special Notes
MAO-B inhibitors  
Rasagiline Azilect® 0.5mg tab Headache, nausea First-line therapy or add-on therapy
1mg tab
Selegiline Eldepryl® 5mg tab Dizziness, hallucinations, difficulty sleeping, agitation, vivid dreams Add-on therapy If taking twice daily, take in the morning and at noon/early afternoon.
5mg capsule
Selegiline oral-disintegrating Zelapar® 1.25mg tab Dizziness, hallucinations, difficulty sleeping, vivid dreams Add-on therapy Used once daily in the morning.

Anticholinergics:

Anticholinergic medications decrease the effects of acetylcholine, a chemical in the brain. Acetylcholine and dopamine sit on opposite ends of a teeter totter, and when dopamine is decreased in PD, the acetylcholine becomes the dominant chemical. By opposing the effects of acetylcholine, anticholinergics help to restore the correct balance of dopamine and acetylcholine. These medications are particularly beneficial to treat tremor, although side effects may limit their use. The anticholinergics most commonly used to treat PD are benztropine (Cogentin) and trihexyphenidyl (Artane).

Generic Name Brand Name Available Dosages Possible Side Effects Role in PD Therapy Special Notes
Anticholinergics  
Benztropine Cogentin® 0.5mg tab Confusion, dry mouth, constipation, sleepiness, blurred vision, dizziness, urinary retention Second line for tremor Used with caution in elderly due to side effects.
1mg tab
2mg tab
Trihexyphenidyl Artane® 2mg tab Confusion, dry mouth, constipation, sleepiness, blurred vision, dizziness, urinary retention Second line for tremor Used with caution in elderly due to side effects.
5mg tab
2mg/5mL elixir

Other:

Originally used to prevent influenza, amantadine (Symmetrel) can be used for the motor symptoms of PD, particularly tremor. More often, however, it is used to treat dyskinesia that happens with levodopa therapy. How exactly amantadine does this is a mystery, but it can provide some relief to patients with severe dyskinesia.

Generic Name Brand Name Available Dosages Possible Side Effects Role in PD Therapy Special Notes
Other  
Amantadine Symmetrel® 100mg tab Dry mouth, constipation, blurred vision, dizziness, confusion, skin blotches/discoloration, leg swelling/water retention Dyskinesia due to levodopa This medication should be given at a lower dose in someone with decreased kidney function.
100mg capsule
50mg/5mL oral solution
50mg/5mL oral syrup

Supplements

Before starting any new supplement, always talk to your healthcare provider to make sure it is safe and won’t conflict with any of your other medications or health conditions.

Coenzyme Q10.

Coenzyme Q10 has received a lot of publicity for a possible role as a neuroprotective therapy for Parkinson’s disease (PD). Research has shown that people with PD have low levels of coenzyme Q10 in their brains. One small research trial showed slight positive results in movement at a dose of 1200mg per day. Currently, a much larger trial (the QE3 trial) is underway to determine the role of coenzyme Q10 in the treatment of PD. Coenzyme Q10 is involved in the way our bodies use energy, and it seems to be highly concentrated in the heart and brain. There are typically very few side effects from taking coenzyme Q10, although it can be expensive.

Creatine,

Like coenzyme Q10, is being studied as a possible neuroprotective therapy, or a therapy that may slow PD progression. Creatine is a component of the energy-building system in our body’s cells. It is often used by athletes to enhance exercise performance and build muscle mass. For PD, doses of 5 to 10 grams daily are under study. Possible side effects of creatine include weight gain (generally due to fluid or “water” retention), nausea, headache, and possibly joint pain. Creatine should be used cautiously and only under physicians supervision.

Glutathione.

Glutathione is an antioxidant, which works to prevent damage to our body’s cells. Although we all have glutathione naturally in our bodies, it seems that the amount decreases with age and also in certain medical conditions, such as PD and diabetes. More studies of glutathione are needed in PD to determine if it has a role in treating PD. Glutathione is given as an injection into the veins. However, this is poorly studied to date and very few, if any, neurologists recommend that it be used this way until more research is performed.

Vitamin D.

Some research has shown that people with low levels of vitamin D, something we get from sunlight and certain foods, are at increased risk for PD. You can ask your healthcare provider to test your vitamin D level to see if you are low. If so, you may need to take a vitamin D supplement to bring your levels back to normal.

Vitamin E.

Eating a diet with plenty of vitamin E may reduce the symptoms for PD. Some healthcare providers recommend a vitamin E supplement, but it is unclear whether this is as beneficial as food with vitamin E. Foods that contain high levels of vitamin E include nuts, wheat germ, spinach, and other green leafy vegetables.

Non-Drug Treatments

Equally as important as medications are the non-drug treatments for PD. There are a number of ways someone with PD can improve their quality of life .

Excercise

Although exercise may be a four letter word to some of us, it is truly the best thing that someone with PD can do for themselves. Over and over research is proving the benefits of exercise in PD. In fact, exercise may actually be neuroprotective! Knowing that you might actually be slowing down PD progression can be a huge motivator.

Use it or lose it! Exercise helps to maintain muscle strength and flexibility, overall fitness, and even improves mood. Exercise is actually better than medication at improving balance. The key is to find an activity you enjoy doing, whether it is walking with friends, swimming, aerobics, dancing, gardening, etc. If you’re not sure how to start, ask a physical therapist to help you with a workout routine that includes aerobic exercise, stretching, and weight-bearing exercises.

Nutrition

Eating a varied diet that is full of fruits and vegetables is a goal for everyone, PD or not. Look for fruits and vegetables that are rich in color, indicating they are full of antioxidants. Because PD can increase the risk of falling, bone health is especially important. Make sure to eat plenty of foods that are rich in calcium, which helps protect bones. Foods that contain calcium include dairy products (e.g., milk, cheese, yogurt), broccoli, salmon, tofu, and kale, among others.

Physical Therapy

A physical therapist who is knowledgeable about PD can be a great asset. Physical therapy can improve your activity level, increase your muscle strength, decrease slowness, and improve balance. These therapists can give you tips to improve walking and reduce your chances of falling or freezing.

Occupational Therapy

An occupational therapist can show you ways to make your daily activities easier. This allows for independence and increased safety. For example, occupational therapists can check your house for things that are dangerous and suggest aids and modifications to increase your safety and help you with things like cooking, getting dressed, and eating.

Speech Therapy

Although they might not notice it, many people with PD have a soft, quiet voice. PD also can cause drooling and difficulty with swallowing. A speech therapist can target all of these issues to increase the strength of one’s voice and improve swallowing.

Support Groups/Counseling

Support groups are a great chance to meet other people with PD who are experiencing similar tribulations. It can be therapeutic to know that you’re not alone and talk with people who are fighting the same battle.

Surgery

For patients who have significant side effects from their medications, such as dyskinesias or fluctuations in their response to medications, there are surgical options.

Deep Brain Stimulation Surgery

(DBS) is one surgery for PD. In DBS, electrodes are placed in the brain to stimulate certain areas of the brain that are responsible for the movement problems in PD. DBS is actually two surgeries. During the first surgery, the electrodes are placed in the brain. In the second surgery, which occurs about a week after the first, a surgeon takes the wires from the electrodes and runs them down the person’s neck to the battery, which is about the size of a pacemaker and sits near the   collarbone.

DBS is very effective for people who have a good response to medications. People with Parkinson’s Plus syndromes are not candidates for DBS, nor are people with PD and dementia. After DBS surgery, most patients with PD   notice they have much less fluctuation with their medications and don’t have to take as much medication.

If DBS is not an option, there is also a procedure called the gamma knife. A gamma knife is a machine that sends out radiation to a specific target. It is particularly helpful for people who uncontrollable tremor and cannot undergo DBS.