Parkinson’s disease

Parkinson’s disease (PD) is the most common movement disorder.

It is a slowly progressive neurodegenerative disorder that causes a range of motor and non-motor symptoms which develop slowly over time.

Although there’s currently no cure for Parkinson’s, a range of drugs, treatments and therapies are available to manage the symptoms.

Parkinson’s disease most commonly occurs during the person’s 60s, however it can affect people of any age.

It is more common in men than in women.

PD affects the basal ganglia situated in the deep part of the brain. The basal ganglia control well learned, automatic movements, such as writing and walking. As PD progresses, other part of the brain are affected.

Diagnosis of Parkinson’s disease

Parkinson’s disease can be difficult to diagnose in the early stages. There are currently no diagnostic tests available to confirm PD.

A neurologist specialising in movement disorders is the recommended medical person to see when seeking a diagnosis.

There are common PD symptoms but these vary between people and can also present in other disorders. Diagnosis may be quick for some people but may take months for others.

The doctor may arrive at the diagnosis of PD after ruling out other causes of the symptoms and if the person has a positive response to a trial of PD medication.

Causes of Parkinson’s disease

Parkinson’s disease causes the death of the cells that produce dopamine located in the substantia nigra, which is part of the basal ganglia.

The cause of these changes is largely unknown.

The key change found in the brain of someone with PD is the presence of Lewy bodies. In Parkinson’s disease a protein called alpha synuclein misfolds and goes on to form large clumps or Lewy bodies, which disrupt the normal functioning of the brain.

It is thought that a combination of genes, environmental and lifestyle factors determines if someone will develop PD.

Genetics

Genetics explains about 10% to 15% of cases. Familial PD where the faulty gene is passed down through the generations is rare. Scientists have discovered many gene mutations that are linked to PD but they are still to determine how these mutations contribute to this disorder. Having one of the genetic mutations does not mean the person will go on to develop PD.

Environmental risk factors

Studies that have investigated the relationship between PD and occupations, exposure to metals and certain chemicals have been inconsistent in their findings. A strong link has been found, however, between exposure to certain pesticides and herbicides and PD.

Protective factors

Studies have suggested that certain factors may decrease the risk of developing PD.  Being regularly physically active early in life appears to lower the risk of developing PD. It is less clear if other factors such as anti-inflammatory drugs, statins, caffeine, or high vitamin D levels, also reduce the risk.

Symptoms of Parkinson’s Disease

The early physical or motor symptoms of PD include:

  • stiffness (rigidity)
  • slow or reduced movement size (bradykinesia/hypokinesia) e.g. slow walking, small writing or micrographia, masking of the face, soft voice
  • tremor at rest

Motor symptoms start on one side of the body.

The early non-motor symptoms are varied and may include:

  • loss of sense smell
  • sleep disturbance (REM sleep behaviour disorder)
  • constipation
  • mood disorders e.g. depression
  • fatigue
  • problems with memory, planning, etc
  • bladder problems e.g. frequency, urgency, incontinence
  • pain

Having some of the signs listed above does not mean the person has PD as they are very common with ageing, however if they have 2 or more, then they should consider discussing them with their doctor.

As PD progresses and there are fewer dopamine producing cells in the brain, motor and non-motor changes become more pronounced. Worsening symptoms cause greater disturbance to the person’s function making them increasingly dependent on others for their everyday activities. Motor symptoms by now affect both sides of the body.

The following are some of the more disruptive changes in mid to late PD.

Movement changes

The ongoing loss of dopamine causes movement to become progressively slower and smaller. When the PD medications are working, movement can still be performed even if slowly but when the medications wear off, the person is often unable to move without assistance.

Walking

Walking becomes slower with shuffling and foot drag, there can be little or no arm swing when walking, stepping may become faster and smaller (festination) and stepping may stop involuntarily, called ‘freezing of gait’.  All of these changes can all increase the risk of falling. As PD progresses, PD medications can become less effective at controlling these changes.

Freezing of gait typically presents in the mid to late stages of PD, worsening over time.

There are many triggers to freezing of gait including:

  • starting to walk
  • approaching or walking through doorways
  • performing another task when walking, such as talking
  • turning
  • sudden distractions, such as dog barking, phone ringing

Balance and falls

Mild balance changes are commonly present from the time of diagnosis but generally don’t interfere with mobility and walking until the mid stages. The combination of walking and balance changes leads to a marked increase in the risk of falls when walking.

By the mid stages of PD over 60% of people with PD will experience a fall in a 12 month period.

Turning is a simple activity that all people perform numerous times a day, however, turning is one of the high falls risk movements in PD. Festination and freezing of gait are commonly triggered by turning thus increasing the risk of falls.

Tremor

Tremor is not present in everyone who has PD. Tremor due to PD usually presents only at rest and stops during voluntary movement. In the early stages of PD, tremor affects limbs on one side of the body, and is most noticeable in the hand or foot. Tremor can also develop in the lips, chin and jaw.
Tremor can cause embarrassment leading the person to withdraw from their social network. There can be other causes of tremor, such as the condition essential tremor or it can be a side effect of medications and stress. A neurologist specialised in movement disorders will be able to determine the cause of the tremor.

Speech and swallowing

As speech and swallowing are motor tasks, they usually worsen over time as more dopamine producing cells are lost in the brain.

Speech symptoms can vary between people with PD.  A person with PD may have difficulty communicating because of the following changes:

  • soft voice due to loss of volume
  • monotone voice with loss of intonation
  • slurring or mumbling of words
  • fast speed of talking and stammering or ‘freezing’
  • difficulty finding words causing speech to slow
  • loss of facial expression.

Swallowing and eating difficulties, known as dysphagia, are thought to affect over 90% of all people with PD.  Common swallowing problems include:

  • struggling to chew and swallow tough food such as steak
  • difficulty swallowing tablets which may feel ‘stuck’ in the throat or oesophagus
  • coughing especially after having a drink and choking on solid foods such as nuts or toast.

Swallowing difficulties increase the risk of aspirating food or fluids into the lungs which may then lead to pneumonia.

The automatic swallowing of saliva can be disrupted in PD leading to drooling. Excessive flexed posture of the trunk and head can make drooling worse.

Some people may have the reverse and experience a dry mouth.

Drooling may cause social embarrassment as well as oral hygiene problems.

Stooped posture

Stooped posture can become exaggerated as PD progresses.

Weakness contributes to this excessive stooping however the decrease in dopamine results in the loss of the ‘automatic’ reminder to keep an upright posture. The less dopamine the worse the stooped posture. Posture can improve when the PD medications are working (‘on’ time) and worsen when they’re not (‘off’ time).

Excessive stooped posture can result in neck and back pain, difficulty eating and swallowing, disruption to speech and communication, increased difficulty with personal care such as shaving and dressing and difficulty maintaining balance.

Dystonia can also cause a flexed posture.

Dystonia

Dystonia is similar to muscles cramps but the muscle tightening is sustained causing joints to stiffen and often twist. Dystonia can be very painful.

Dystonia can be present in one part of the body, such as the arm, or several parts, such as the arm and leg usually on the same side, as well as face, neck and trunk. Dystonia in the feet can cause the toes to claw and the foot may turn inwards at the ankle.

Dystonia can be a symptom of PD or a side effect of PD medications.

It can present when the PD medications have worn off (‘off dystonia’) or when the effect of the medications is at its peak (‘on dystonia’).

Dystonia is more common in people who were young when they were diagnosed with PD.

Dyskinesias

These are involuntary random movements that are described by people as irregular jerking, wiggling or twitching movements.

Dyskinesia is thought to be a result of the long term use of PD medications, in particular levodopa, and also part of the normal progression of PD. Dyskinesia develops during the mid to advanced stages of PD.

Dyskinesia occurs when effect of PD medications are at their peak, and rarely when their effect is wearing off.

Excessive dyskinesia can make everyday tasks difficult to perform, such as dressing and eating. Dyskineia can disturb a person’s balance, cause excessive sweating and weight loss.

Non-Motor Symptoms

There are a range of non-motor symptoms that, like the motor symptoms, worsen as the loss of dopamine increases. Not everyone will go on to develop all of these non-motor symptoms.

Among the more common non-motor symptoms experienced as the PD progresses are:

  • cognitive changes, such as difficulty concentrating when reading or conversing, poor memory, difficulty planning tasks, difficulty following instructions and even dementia in the very advanced stages.
  • fatigue that limits everyday activities
  • mood changes such as depression, anxiety and apathy
  • hallucinations and psychosis
  • difficult to control low blood pressure causing dizziness or fainting
  • difficulty with bowels such constipation and incontinence
  • difficulty with bladder such as urgency, frequency and incontinence
  • pain
  • weight loss
  • worsening sleep disorder, such as insomnia, excessive day time sleepiness, vivid distressing dreams

Stages of Parkinson’s disease

Parkinson’s disease affects people differently. Though everyone with PD will experience slowness of movement and stiffness, not everyone will experience the full range of possible symptoms. Parkinson’s disease is seen to progress through 4 broad clinical stages.

Early stage of the disorder is when symptoms are mild and initially affect one side of the body. The common motor symptoms include tremor, slowness of movement in the leg or arm on one side, stiffness and decreased facial expression. The person is still able to perform their usual activities and they are fully independent, unless they have another health condition. Symptoms are well controlled by medications. This period usually lasts for a maximum of 5 years from the time of diagnosis.

Fluctuation stage is when the benefits from the PD medications start to wear off before the next tablet is due to be taken and the person experiences the re-emergence of their symptoms. This stage requires the medications to be adjusted so that the slowing down or ‘end-of-dose’ periods are controlled. By this stage symptoms affect both sides of the body.

Mid stage is when falls become common and it is more difficult to adjust the PD medications in order to control the symptoms. The control of motor symptoms may not be possible with medications alone. It is common for deep brain stimulation to be considered at this stage.  The person can still walk without assistance but they may need a walking aid at times to be safe.  The person is still fully independent in their daily living activities, such as dressing and domestic tasks but they are slower performing them. Non-motor symptoms become problematic in this stage.

Late stage sees the person severely disabled by their symptoms. Falls risk is very high and a walking aid is usually needed all of the time. They need assistance to remain at home. Non-motor symptoms, such as hallucinations, generally worsen in the late stage.

Eventually the person is confined to a chair or bed and can only stand up and walk with the assistance of another person. Balance control is severely affected causing the person to fall spontaneously unless assisted. Eating and swallowing are often compromised resulting in risk of choking and aspirating. Eventually full time care is required.

Treatment for Parkinson’s disease

A multidisciplinary team that includes a neurologist and therapists who specialise in movement disorders is recommended for the management of the complex PD symptoms. The appropriate multidisciplinary team members should be seen from the time the diagnosis of PD is received.

The advancement in the treatment options for PD over the last few decades has meant the progression of disabilities can be slowed and a good quality of life maintained. The following is an overview of current treatments that have good evidence to support their effectiveness.

Medical treatment

A neurologist specialised in movement disorders can advise on medical treatments to treat the presenting symptoms.

Medication

PD medications are used to control symptoms and do not reverse the disorder. The type of medication, the dosage and timing is determined by the doctor after consultation with the person with PD and their caregiver or family and is tailored to the individual. It is important that the person with PD adhere to the schedule recommended by their doctor in order to gain the greatest benefit from the medications.

Levodopa preparations

Levodopa is usually the first-line drug prescribed for PD. Levodopa preparations replace the dopamine that is no longer produced naturally by the brain. Levodopa is converted into dopamine in the brain and is taken to improve motor symptoms, such as stiffness and slowness of movement and tremor.

The common brands available include Sinemet, Madopar and Kinson which come in various preparations and strengths. They are available in immediate release, long acting (Sinemet CR, Madopar HBS) and rapid acting (when dissolved in water (Madopar rapid)). Levodopa preparations are available in combination with other drugs (Stalevo) and in gel form, Duodopa.

Dopamine agonist preparations

Dopamine agonists work by stimulating the dopamine receptors of the brain. They are considered not to be as powerful as levodopa drugs however they can be very effective at controlling involuntary movements (dyskinesia) associated with taking levodopa and motor fluctuations(‘off’ times when symptoms re-emerge). They can be taken either alone or in combination with levodopa drugs across the stages of PD.

Dopamine agonists available in Australia include Pramipexole (Sifrol), Cabergoline (Cabaser), Rotigotine (NeuproPatan), Apomormorphine (Movapo).

COMT Inhibitors

COMT inhibitors work by blocking an enzyme present in the body which converts the levodopa into a form that cannot be used by the body.  By blocking this process the amount of dopamine available in the brain increases. They are often commenced when ‘wearing off’ or motor fluctuations develop. COMT inhibitors available are Entacapone (Comtan) and Tolcapone (Tasmar).

MAO-B Inhibitors

MAO-B inhibitors block an enzyme present in the brain that breaks down dopamine so that more dopamine is available for treating motor symptoms. The inhibitors also have some effect in controlling the motor symptoms and as such may be the first drug of use in the early stages. MAO-B inhibitors may be used initially on their own or in combination with other PD medications.

Selegiline (Elderpryl) and Rasagiline (Azilect) are the common MAO-B inhibitors used.

Amantadine

This drug is used along with levodopa to treat dyskinesias.

Anticholinergic drugs

These drugs are used to treat tremor and dystonia or muscle cramps due to PD. The common ones available include Artane and Cogentin, however as they both may cause confusion and hallucinations, they are usually avoided in older adults.

Advanced medical treatment options

There are several medical approaches used to improve the symptoms of PD in the mid to advanced stages, including:

  • Deep brain stimulation, the most commonly used surgical approach
  • Intestinal infusion pump for continuous delivery of Duodopa
  • Infusion of apomorphine

The use of other forms of brain surgery including thalamotomy, pallidotomy and subthalamotomy are less common and have largely been replaced by DBS surgery.

Deep brain stimulation (DBS) surgery

DBS surgery has been available for over 20 years and is used to treat troublesome tremor, to prevent ‘off’ times and to moderate excessive dyskinesia. Recently there is a shift to perform DBS in the early stages of PD in an effort to delay the onset of disabilities and to maintain good quality of life for longer.

DBS surgery involves inserting electrodes into targeted areas of the basal ganglia, usually the sub thalamic nucleus. The electrodes are connected to an impulse generator battery that is inserted under the collar bone. The generator provides impulses to the brain via the electrodes. Usually the PD medications can be reduced dramatically after surgery.

Intestinal infusion pump for delivery of Duodopa

Duodopa is a gel form of levodopa and is used to treat severe motor fluctuations with prolonged and disabling ‘off’ times and troublesome dyskinesia.

A PEG-J tube is inserted into the intestine via a stoma or hole in the stomach wall. A cassette containing the gel is inserted into a pump worn by the person that is programmed to deliver the gel at the required rate.

Apomorphine

Apomorphine is usually used for more advanced Parkinson’s, when a person’s symptoms no longer respond well to oral drug treatments.

Apomorphine is given by injection or continuous infusion, using a pump.

  • An APO-go PEN is pre-filled and disposable to be used as needed.
  • A portable, battery driven pump is used to delivery apomorphine from a pre-filled syringe (APO-go PFS) over a period of several hours.
  • For infusion over longer periods apomorphine, stored in glass vials called ampoules, is delivered using a portable battery-driven pump (a syringe driver).

For all three methods, the apomorphine is given through a fine needle inserted into the fatty layer under the skin (a subcutaneous injection).

Education regarding Parkinson’s disease and managing medications

A nurse with specialist training in PD can provide education and support to the person with PD and their caregiver. This may include:

  • monitoring the effects of changes to PD medications as recommended by the neurologist and liaising with the neurologist
  • providing education and support around the recommended PD medications and assist with the minimisation of side effects
  • providing individualised education for the person with PD and their caregivers to ensure optimal understanding and management of the various PD symptoms as the condition progresses
  • arranging referrals to other relevant health professionals within the specialist team

Treatments for walking difficulties, balance, falls and posture problems

Physical Exercise

Research shows that regular exercise can improve walking, balance, mood and cognition for people with PD. In addition, regular exercise can improve many of the secondary deficits of PD, such as loss of fitness and strength.

A physiotherapist specialised in Parkinson’s disease can tailor an exercise program that meets the needs of the person.

Participating in moderate level of exercise or physical activity on a regular basis has been shown to decrease the risk of developing PD, and in those who have PD, to slow down the development of disability and to maintain a good quality of life for longer.

Regular physical activity is essential for all people with PD, regardless of the stage they are at.

Exercises that have been shown to be effective in PD include movement strategy training, progressive strength training, balance training, treadmill training and flexibility exercises.

To date no one form of physical exercise has been shown to be better than another.

Movement strategy training uses attention to normalise movement.  Movement size is reduced in PD but attentional strategies return movement to its normal size by by-passing the basal ganglia. Walking speed can be normalised in PD if the person concentrates on taking long steps. Everyday activities, such as getting into bed, getting out of a chair, can be improved using strategy training.

A physiotherapist specialised in PD can assess the person’s movement problem and advise on the best strategies to use.

Attending a local gym may be adequate in the early stages of PD the focus on strength, fitness, balance and flexibility. A physiotherapist or exercise physiologist with knowledge about PD can provide advice on the type of exercises that are likely to be beneficial.

Research shows non-traditional forms of activity for people with PD, such as dance and Tai Chi can also be beneficial. Dance is a social activity and as well as improving movement, it also improves mood. Tai Chi has been found to decrease falls rate and improve balance.

In the mid stage of PD, a physiotherapist is best suited to manage the more complex motor symptoms and secondary effects of PD. The physiotherapist will assess the person with PD, determine the main problems and plan an exercise program that will benefit them most. Depending on factors such as safety and ability to exercise alone the exercise program may be based at home, in the clinic or a mixture of the two.

Equipment and home modifications

In the later stages of PD, walking frames, home modifications (such as installing ramps to replace steps and grab rails in the bathroom) are often needed due to balance and walking difficulties. A physiotherapist is the best person to advise on the type of walking frame and an occupational therapist can advise on home modifications.

An Occupational therapist can also provide tips on how to make dressing easier, how to be safe when showering, make eating easier using adaptive cutlery and correct seating, what you need to know about PD and driving, tips on how to continue traveling and strategies to remind you to take your medications on time.

If the person is confined to bed or a wheelchair in the advanced stage, an occupational therapist and physiotherapist can advise on equipment which helps position them to avoid skin lesions (pressure injuries), provide comfort and supports the body.  This will also help the person to eat and communicate more effectively.

There are various funding bodies that can fully or partially cover the cost of some home modifications and adaptive equipment such the State Wide Equipment Program (SWEP). An occupational therapist can advise you on how to apply for funds to assist with the costs if required.

Treatments for speech and swallowing difficulties

Speech and swallowing problems for people with PD also respond to exercise or strategies.  A speech pathologist specialised in movement disorders such as PD can assess the person’s speech and teach strategies to improve it.

Speech can be improved through particular exercises and programs such as the Lee Silverman Voice Therapy, Parkinson Voice Project SPEAK OUT!

Often identifying strategies to improve the communication environment or method can lead to more successful speech. Strategies and communication partner training can become invaluable to family and friends if a person with Parkinson’s is experiencing cognitive changes which impact on communication such as word finding difficulties.   Communication Devices such as amplifiers can help to increase volume and other devices or apps can be used when an alternative to speech is needed.  Speech Pathologists can help guide you through what is available and potential avenues to help fund these aids.

Swallowing difficulties (dysphagia) are more common in the later stages of PD and need to be investigated by a speech pathologist. Assessment may involve observing a meal or snack and completing an x-ray study call a videofluoroscopy.  Once the reason for the dysphagia is identified the speech pathologist will advise on how to manage the difficulty. This may involve strengthening exercises for muscles involved in swallowing, modification to the diet and adaptive behavioural strategies such as improving head and neck posture.

A speech pathologist may work with an occupational therapist and physiotherapist to decide on equipment or adaptive seating that helps the person achieve the best possible posture to facilitate swallowing.

When swallowing is difficult your speech pathologist and dietitian will work together to ensure you get sufficient nutritional intake. Your drinks may need to be thickened to make them easier to swallow and lessen the risk of aspirating. Your foods may need to be modified to a soft-moist, mashed or puree texture to make swallowing easier and safer. In some situations you may require a tube to be inserted directly into your stomach so you can receive most or all of your nutritional intake via the tube.

A speech pathologist can suggest ways to improve your drooling due to excessive saliva, such as being conscious to swallow often, using gum to remind you to swallow and upright posture. Oral hygiene is important if you experience a build-up of saliva in your mouth or a dry mouth.  A speech pathologist can advise on how to optimise your oral hygiene.

Management of nutrition

Adequate intake of nutritional food is essential with PD.

There are no special diets needed, but manipulation of what you eat and drink can help manage loss of appetite, loss of weight, constipation, chewing and swallowing difficulties, and reduce the impact that certain foods can have on the effectiveness and absorption of PD medications.

A dietician specialised in movement disorders such as PD can assess the person’s nutritional needs and make appropriate recommendations.

A dietitian is a person qualified in nutrition and dietetics who is trained to provide advice in health and disease by applying the science of nutrition.

A dietitian will assess your current dietary intake and provide advice on ways to manipulate it to help manage any nutrition related problems you may be experiencing. They can determine if your weight is suitable for you and plan short and long term goals to achieve your optimal weight taking into consideration causes that may be impacting. Loss of weight can occur due to loss of appetite, excessive dyskinesia, swallowing difficulties or constipation; weight gain (less common in PD) often occurs in people who have had deep brain stimulation.

Ensuring you consume enough protein for what your body needs is important for the growth and repair of your body, essential for your muscle and overall health and important to avoid weight loss. Protein can sometimes impact on the efficacy and action of your PD medications, causing you to go ‘off’ or slow down after meal times. It is essential not to avoid protein in your eating plan, and your dietitian can advise on ways of reducing the impact dietary protein has on your PD meds, without compromising your protein and nutrient needs.

Oral nutrition supplements may be suggested by your dietitian to help improve your overall nutritional intake. They may also be used if eating and swallowing problems are contributing to your poor food intake. Your dietitian will work with your speech pathologist to develop the best ways to improve this.

Managing the social and emotional impact

The effects of PD are broad and impact on the social and economic life of the person and their family from the time of diagnosis in a variety of ways.

Coping and adjusting to the diagnosis, facing increasing challenges at work and planning for the future can be a daunting undertaking.

Navigating this newfound uncertainty requires careful consideration and appropriate specialised support.

As the disorder progresses, caregiver burden also increases and quality of life can decrease.

A social worker specialised in movement disorders such as PD can assist the person with PD, their caregiver and family negotiate the challenges faced across the life time of the person’s PD.

Social workers are highly skilled professionals who can assist you and your loved ones by:

  • providing a range of different therapy’s like counselling
  • assistance with linking to other support services
  • directing you to financial support services
  • information provision of entitlements for care packages
  • help to facilitate suitable respite arrangements for the caregiver
  • assistance and support with navigating the pathway to permanent residential care if the need arises.

After receiving a diagnosis of PD it is normal to experience a change in mood. A social worker has the appropriate specialised skills to help you deal with the reaction to your diagnosis.

Depression and anxiety are common clinical symptoms of Parkinson’s disease. Depression and anxiety can benefit from a variety of interventions and approaches. It is important to talk openly with your doctor or neurologist if experiencing any of these to determine the best treatment plan for you.

Social workers are specifically trained to support you in understanding how best to manage such symptoms.

Cognition

PD causes changes to the person’s cognition. Cognition refers to our mental processes and includes the ability to learn, to reason and remember.

A neuropsychologist specialised in movement disorders such as PD can assess a person’s cognition and provide strategies to optimise independence.

Changes in cognition affect up to 40% of people at the time of diagnosis. They may present as slowness in thinking, problems with attention or concentration, difficulty making decisions, problem solving and planning difficulties. They can be so mild that they are not obvious to the person, family or work colleagues.

Cognitive changes may, however, interfere with work and the person’s daily activities which can cause frustration.

Levodopa medication, such as sinemet, can improve cognitive processes, such as speed of thought processes, in the early to mid stages. However in the later stages, PD medications may interfere with cognition.

There are specialists, such as a neuropsychologist, who can assess the severity of these changes.

A neuropsychologist can assess cognition when the person is experiencing problems that are interfering with their ability to work or live independently. The neuropsychologist will suggest strategies to use to address the underlying cognitive problems.

An occupational therapist specialised in PD also has the skills to train the person in the use of a range of strategies such as using attention, breaking activity into small parts before performing, use of cue cards, use of lists.

A speech pathologist can also help when communication is disrupted due to word finding difficulties.

Complementary therapies

Complimentary treatments are nonmainstream interventions used alongside conventional medicine. These may include dietary modifications, vitamins, herbs and botanicals, cannabis, iron and chelation therapy and mindfulness using meditation. Physical treatments include Tai Chi, yoga, dance therapy, music therapy, light therapy, whole body vibration and acupuncture.

Because most complimentary treatments for PD are not supported by good quality evidence, people with PD are advised to discuss treatments with their doctor before trying them. It is advisable to select a therapist who is qualified and registered with a professional body.

These are some of the complementary therapies you may read about. The evidence and risks are summarized here for you. This information has been accessed from a review article by Marcie L. Rabin,et al. in Movement Disorders Clinical Practice 2015, Vol 2(3) titled Complementary Therapies for Parkinson’s Disease: What’s Promoted, Rationale, Potential Risks and Benefits

Complimentary treatments, evidence and risks

  • Reduced protein diets for motor fluctuations – little evidence to support benefits or risk of malnutrition
  • Protein redistribution diet for motor fluctuations – some support for benefits. Risk of malnutrition & weight loss
  • Mediterranean diet – 13% reduction in incidence of PD. No evidence for benefits once PD is present
  • Coffee – some evidence reduces risk of PD. No evidence for benefits once PD is present
  • Antioxidants as nutritional supplements – all research remains inconclusive
  • Vitamins Bet-carotene, B3, B6, C, D, E – insufficient evidence to recommend their use in PD
  • Herbs and Botanicals – Flavanoids, Gastrodin, green tea phenols, Ginkgo biloba, Milk thistle – insufficient evidence to recommend their use in PD
  • Coenzyme Q10 – insufficient evidence to recommend their use in PD
  • Fish oil – no evidence that it is beneficial for PD
  • Iron and Chelation Therapy – no proven benefit in PD
  • Medical marijuana – more research needed to evaluate safety and benefits
  • Light therapy for seasonal depression and sleep disturbance – limited evidence showing improvement in PD symptoms and mood
  • Whole body vibration – cannot be recommended at moment due to lack of consistent evidence of benefits
  • Acupuncture – cannot be recommended at moment due to lack of consistent evidence of benefits; more rigorous studies are needed
  • Mindfulness using medication – no or little evidence published for PD
Stay informed with the latest updates on coronavirus (COVID-19).Find out more
+