Parkinson's Disease:
Ten Tips for Patients

Gary E Cordingley, MD, PhD
Although Parkinson's disease is treatable, it can still interfere
with one's quality of life. However, awareness of certain tricks of
the trade and nuances of treatment can enable Parkinson
patients to maximize function and independence.
Parkinson's disease is a condition for which available treatments are both wonderful and
inadequate. They're wonderful because they improve the ability of patients to function
and maintain independence. They're inadequate because they don't stop the underlying
disease from worsening over time and they don’t address all the patient's needs. If you
have Parkinson's disease, you need to grab every edge you can. Here are ten tips that
your doctor probably agrees with, but doesn't have time to emphasize at each visit.

The first five points have to do with getting the most benefit from your medication. The
next three have to do with maximizing function. The last two have to do with staying

1. Put your morning dose of medication and a glass of water on your nightstand.

Many people with Parkinson's disease find that their ability to move around freely is worst
in the morning. This might be because their last dose of medication, taken the previous
evening, is already wearing off. By the time their morning dose has a chance to take
effect, they have already been up and around for a while. The trick here is to plan ahead.
Before retiring for the night, set tomorrow morning's first dose on the nightstand along
with a glass of water. In the morning, take your dose as the first thing you do. Then the
medication is already getting into your system while you're going through your morning
routine. You can even set the alarm clock for an hour before you plan to awaken so you
can take the dose and then roll over for another hour of sleep. By the time you get up for
good, the morning dose has already gotten a head start.

2. Pay attention to whether you take your pills with food.

It's neither wrong nor right to take your pills with food, but there are consequences. In
general, when you take your medication on an empty stomach, more of it is absorbed into
your bloodstream. On the other hand, if your medication makes you queasy, then you can
minimize this by taking it at mealtime.

3. Avoid most anti-nausea medications.

Most anti-nausea medications can worsen the symptoms of Parkinson's disease or
interfere with the benefits of Parkinson medication. Some of the most common anti-
nausea drugs, e.g. metoclopramide (Reglan), promethazine (Phenergan) and
prochlorperazine (Compazine) block the body's chemical dopamine receptors. These are
the very receptors that most Parkinson medications seek to activate. Taking anti-nausea
drugs while also taking Parkinson medications means that you're taking a drug and its
antidote at the same time. They cancel each other out. However, one anti-nausea drug,
ondansetron (Zofran), works on a different chemical receptor and avoids this problem.

4. Be mindful of forgetfulness.

People with Parkinson's disease may already be more prone to forgetfulness because of
either their disease or their age. But certain medications used for Parkinson's disease, e.
g. benztropine (Cogentin) and trihexyphenidyl (Artane), or urinary incontinence, e.g.
tolterodine (Detrol) and oxybutynin (Ditropan), can worsen memory. So if you're having
trouble remembering things, you should tell your doctor. A simple medication adjustment
might resolve the problem.

5. Know the difference between tremors and dyskinesias.

Parkinson's disease often causes tremors, which are rhythmic oscillations of hands or
other parts of the body. However, many Parkinson medications, when dosed high enough,
can produce another kind of excessive, involuntary movements called dyskinesias. These
might involve muscles of the face, neck, trunk, arms or legs, and have the appearance of
wiggles and fidgets rather than of rhythmic oscillations. Distinguishing between these
different movement disorders is important because the presence of one might mean that
the dose of medication should be increased, while the presence of the other might mean
that the dose should be decreased.

6. Swallow your pride and use a walking stick.

As symptoms of Parkinson's disease slowly worsen over the years, imbalance can make
walking less safe and secure. Yet many patients avoid using walking sticks, canes or
walkers. Sometimes they even buy these gait-stabilizing devices, but leave them in the
closet, unused. I hear patients say that they don't like the idea of "giving in" to the disease
by using such devices. I usually reply that wounding one's pride is better than breaking
one's hip in a fall.

7. Take advantage of useful gizmos.

When loss of motor skills interferes with getting dressed, eating food or taking a bath,
then it's time to make use of devices designed to make these and other activities of daily
living easier. Objects as low-tech as button-hooks, dressing sticks, fat-handled utensils,
large-buttoned telephones, grab bars and shower chairs can make life simpler and
promote independence.

8. Mentally rehearse your next move.

Sometimes getting out of a chair requires multiple attempts. Or, when walking is
interrupted by a "freezing attack," an uncomfortably long period of time is required to get
unfrozen and moving again. In these circumstances, the trick is to mentally rehearse the
next move so thoroughly that you can actually picture yourself accomplishing it. Then,
when you actually do try to move, you're more successful.

9. Maintain body weight.

In patients with advanced Parkinson's disease, the mere act of chewing food can require
so much work and effort that dietary intake plummets. If the patient is overweight to start
with, this might be useful to a point, but continued weight loss can threaten health. In such
circumstances, one should take advantage of food supplements that permit intake of
important nutrients with a minimum of effort. This is a good time to indulge one's love of
ice cream and milk shakes, which are packed with protein and calories, and require a
minimum of chewing. Supplementing one's usual diet with a can or two of pre-packaged
products like Ensure or Sustacal adds missing ingredients that prevent weight loss.
Carnation Instant Breakfast provides many of the same ingredients, but at lower cost.

10. Stay flexible by exercising.

You've heard the expression, "Use it or lose it." As a saying, it's trite and overused, but in
Parkinson's disease it is nonetheless true. By exercising the very movements that
Parkinson's disease affects, one can improve them. The emphasis is on flexibility rather
than strength-building. Although pumping iron can be helpful, too, one should focus on
stretching, limbering and range of motion.

(C) 2006 by Gary Cordingley