Parkinson disease treatment options education, support, and therapy

Patient information: Parkinson disease treatment options education, support, and therapy

Author
Daniel Tarsy, MD
Section Editor
Howard I Hurtig, MD
Deputy Editor
John F Dashe, MD, PhD

Disclosures

PARKINSON DISEASE OVERVIEW — Parkinson disease (PD) is a chronic movement disorder that is best managed with a combination of close monitoring, medication, education, support and therapy, exercise, and nutrition. Surgery can be beneficial for some people with Parkinson disease.

This topic will review education, support, exercise and physical therapy, and nutrition for Parkinson disease. The symptoms, diagnosis, and medical treatment of Parkinson disease are discussed separately. (See “Patient information: Parkinson disease symptoms and diagnosis” and “Patient information: Parkinson disease treatment options — medications”.)

PARKINSON DISEASE EDUCATION — Being diagnosed with a chronic disease can be a frightening experience, filled with uncertainty about what the future holds. This is especially true if the person knows a friend or family member who has experienced the disabling effects of Parkinson disease.

In the first months and years after being diagnosed with Parkinson disease, it is important to gather information about initial symptoms and the treatment options that are available.

PARKINSON DISEASE SUPPORT — A person may respond to the diagnosis of Parkinson disease with anger, fear, depression, anxiety, resentment, or a combination of these emotions. Concerns about social and financial well being are common. Support groups can help the patient and family to interact with other individuals who have the same diagnosis to allow these people to share experiences and information. Support groups also provide opportunities to hear speakers talk about various aspects of Parkinson disease. Several national groups are listed below. (See ‘Where to get more information’ below.)

People with young-onset Parkinson disease may benefit from a group composed of similar-aged patients. A handbook for young-onset patients is also available [1].

Other types of support are available for people with Parkinson disease and their families, including psychologic, financial, legal, or occupational counseling. A physician, nurse, or social worker can usually provide contact information for these services in the local area.

EXERCISE AND PHYSICAL THERAPY — Although exercise will not slow the progression of Parkinson disease, it can help patients to feel better, both physically and mentally. Exercise can help to prevent some of the complications of rigidity and flexed (bent) posture, such as shoulder, hip, and back pain. The benefits of exercise will persist as long as exercise continues. Many patients who participate in an exercise program feel more confident and gain a sense of control over their disease.

Simple strengthening and stretching exercises are important for everyone with Parkinson disease. Aerobic exercises, such as walking (outdoors or on a treadmill, with support), swimming, or water aerobics are simple, easy to perform, and usually energizing. A physical therapist can help to develop an individualized program.

PARKINSON DISEASE SAFETY ISSUES

Falls prevention — As Parkinson disease progresses, the risk of falling increases. To reduce this risk, patients and caretakers are encouraged to make the home as safe as possible by:

Installing shower or tub grab-bars
Having adequate lighting in the house, especially at night. Use of light sensitive night-lights or lamps on a timer may be helpful.
Securing loose rugs, which can increase the risk of tripping.
The Centers for Disease Control and Prevention (CDC) has fall prevention materials available online (www.cdc.gov/ncipc/duip/preventadultfalls.htm).

Driving safety — Most people with Parkinson disease can continue to drive as long as their motor symptoms remain mild. Driving ability must be monitored and formally re-evaluated if and when motor and cognitive symptoms worsen. The Association of Driver Rehabilitation Specialists (1-877-529-1830 in the US and Canada) can provide names of local occupational therapists or driving specialists who can perform driving tests to see if Parkinson disease is affecting driving.

If it is necessary to stop or cut back on driving, other forms of transportation are available, and include taxi cabs, shuttle buses, public buses, or trains. Walking, if practical, is always a healthy way to get around. The ElderCare Locator (www.eldercare.gov) is a resource that can provide assistance in locating help with transportation as well as housing, financial or legal services, health insurance, and long-term care.

PARKINSON DISEASE SPEECH THERAPY — Difficulties with speech, including slurred speech and speaking too quietly, are common problems in people with Parkinson disease. These problems develop as muscles weaken in the voice box, throat, mouth, tongue, and lips.

A voice or speech therapist can teach ways to speak more loudly and clearly, conserve energy when speaking (speaking only important words/phrases), and use of nonverbal methods of communication (using a letter or word board, hand signals). Speech therapy may be helpful for improving speech volume.

A speech therapist can also evaluate and treat difficulties with swallowing (dysphagia). Dysphagia can increase the risk of coughing, choking, or inhaling food (aspiration), which can lead to pneumonia. Treatments for dysphagia may include sitting up straight while eating, tilting the head slightly forward, eating small bites and chewing completely, not speaking while eating, or use of a powder to thicken liquids or thin food, making them easier to swallow.

PARKINSON DISEASE NUTRITION — There is no specific diet recommended for people with Parkinson disease, although some patients notice that protein in a meal can block the effect of a dose of levodopa taken around meal time. People who notice this effect should speak to their healthcare provider.

It is important to be sure that the person is consuming an adequate number of calories and nutrients to maintain strength, bone structure, and muscle mass. Problems with unintended weight loss, poor appetite, eating and swallowing, or preparing food should be discussed with a healthcare provider. The provider may recommend meeting with a registered dietitian.

Constipation is a frequent problem for people with Parkinson disease because of disease-related changes in the bowels or as a side effect of Parkinson disease medications. Constipation can sometimes be managed with changes in diet or use of a laxative or stool softener. A full discussion of treatments for constipation is available separately. (See “Patient information: Constipation in adults”.)

WHERE TO GET MORE INFORMATION — Your healthcare provider is the best source of information for questions and concerns related to your medical problem.

 

Related topics for patients, as well as selected articles written for healthcare professionals, are also available. Some of the most relevant are listed below.

Patient Level Information:

Patient information: Parkinson disease symptoms and diagnosis
Patient information: Parkinson disease treatment options — medications
Patient information: Constipation in adults

Professional Level Information:

Bradykinetic movement disorders in children
Clinical manifestations of Parkinson disease
Diagnosis of Parkinson disease
Etiology and pathogenesis of Parkinson disease
Management of comorbid problems associated with Parkinson disease
Motor fluctuations and dyskinesia in Parkinson disease
Neuroprotective therapy for Parkinson disease
Nonpharmacologic management of Parkinson disease
Overview of tremor
Parkinson disease dementia
Pharmacologic treatment of Parkinson disease
Surgical treatment of Parkinson disease

The following organizations also provide reliable health information.

National Library of Medicine
(www.nlm.nih.gov/medlineplus/healthtopics.html)

The National Parkinson Foundation
(www.parkinson.org)

The National Institute of Neurological Disorders and Stroke
(www.ninds.nih.gov/disorders/parkinsons_disease/detail_parkinsons_disease.htm)

The Parkinson’s Disease Foundation
(www.pdf.org)

The We Move Foundation
(www.wemove.org)

REFERENCES
Mark, MH, Sage, JI (Eds). Young Parkinson’s Handbook. The American Parkinson Disease Association, Inc, New York 2000.