What Are The Different Stages Of Parkinsons Disease
Each person with Parkinsons disease experiences symptoms in in their own unique way. Not everyone experiences all symptoms of Parkinsons disease. You may not experience symptoms in the same order as others. Some people may have mild symptoms others may have intense symptoms. How quickly symptoms worsen also varies from individual to individual and is difficult to impossible to predict at the outset.
In general, the disease progresses from early stage to mid-stage to mid-late-stage to advanced stage. This is what typically occurs during each of these stages:
Early stage
Early symptoms of Parkinsons disease are usually mild and typically occur slowly and do not interfere with daily activities. Sometimes early symptoms are not easy to detect or you may think early symptoms are simply normal signs of aging. You may have fatigue or a general sense of uneasiness. You may feel a slight tremor or have difficulty standing.
Often, a family member or friend notices some of the subtle signs before you do. They may notice things like body stiffness or lack of normal movement slow or small handwriting, lack of expression in your face, or difficulty getting out of a chair.
Mid stage
Mid-late stage
Standing and walking are becoming more difficult and may require assistance with a walker. You may need full time help to continue to live at home.
Advanced stage
How Is Parkinsons Treated In The Early Stages
Three main groups of medication are used to treat Parkinsons in the early stages:
- Levodopa : is converted into dopamine in the brain.
- Dopamine agonists: stimulate the nerve receptors responsible for the uptake of dopamine.
- MAO-B inhibitors : block the breakdown of dopamine in the brain.
The medications are usually taken in tablet form. Some dopamine agonists are also available as patches.
In the early stages, some people with mild symptoms cope just fine without medication. If at some stage the symptoms become too much of a problem, levodopa and dopamine agonists are the main medication options. They work slightly differently to each other, and some products may cause side effects more often or have worse side effects than others. But both are very effective in the early stages of the illness. That helps many people with Parkinsons to live a fairly symptom-free life for at least a few years.
Medications To Avoid Or Use With Caution
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Before making any decisions about treatment of Parkinsons disease, you will want to learn about the different types of medications available for Parkinsons disease and discuss the pros and cons of each with your physician. It may help to know that there is no right answer, and if you try something that doesnt work for you, you can always adjust your plan.
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How Is Parkinsons Disease Treated
There is no cure for Parkinsons disease. However, medications and other treatments can help relieve some of your symptoms. Exercise can help your Parkinsons symptoms significantly. In addition, physical therapy, occupational therapy and speech-language therapy can help with walking and balance problems, eating and swallowing challenges and speech problems. Surgery is an option for some patients.
Increased Falls And Loss Of Balance
Parkinsons disease can alter your sense of balance and make simple tasks like walking seem more dangerous. When youre walking, be sure to move slowly so your body can rebalance itself. Here are some other tips to avoid losing your balance:
- Dont try to turn around by pivoting on your foot. Instead, turn yourself around by walking in a U-turn pattern.
- Avoid carrying things while walking. Your hands help your body balance.
- Prepare your home and remove any fall hazards by arranging furniture with wide spaces between each piece. The wide spaces will give you ample room to walk. Position furniture and lighting so that no extension cords are needed and install handrails in hallways, entryways, stairwells, and along walls.
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Adjust Your Drug Dose
Side effects like dyskinesia might be due to the amount of levodopa youre taking. Ask your doctor whether you can lower your dose enough to prevent side effects while still managing your Parkinsons symptoms. It might take some trial and error to get the dose just right.
Another option is to switch to an extended-release form of dopamine. Because the drug releases more slowly into your blood, it prevents the dopamine spikes and valleys that can trigger dyskinesia.
You might also need to add more of a drug. For example, adding extra carbidopa to levodopa can cut down on nausea.
Parkinsons Disease Medications: The Facts
There have been many developments in Parkinson’s disease treatments in recent years. As such, doctors now have a greater understanding of traditional Parkinson’s disease medications and their side-effects. Scientists have also developed new drugs to help control tremors, slowed movement and other Parkinson’s symptoms.
Before we explore the best medication for Parkinson’s disease, it’s important to address the facts. Firstly, Parkinson’s disease medications cannot cure your condition, nor will they slow down the progression of your symptoms. These medications are prescribed to help patients live independently and improve their quality of life.
It’s important to note that some patients do not respond well to Parkinson’s disease medications. In this case, there are plenty of other treatment options to consider such as homeopathic remedies, physical therapy and surgical intervention. Again, none of these treatments provides a cure, but they can help ease or control your symptoms.
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Common Complications And Side
As Parkinsons disease progresses , symptoms have a knock-on effect. Deterioration and impairments in the body can lead to a variety of other health concerns that cause a person great difficulty.
As much as these potential concerns cause discomfort for a person, all are treatable with appropriate medication or therapies.
Associated complications which can arise include:
How to manage some of the more common side-effects of Parkinsons disease
The nature of Parkinsons disease progression means that the condition manifests in a variety of ways, not just in areas of mobility. Non-motor symptoms can sometimes be of more distress to a sufferer, troubling their day-to-day lives even more so than their physical ailments.
Once certain non-motor symptoms are recognised, it is easier to understand why and how they are adversely affecting quality of life, as well as gain control through appropriate treatment.
Other problems which can also be effectively managed include:
Constipation And Digestive Issues
As Parkinsons disease progresses, your digestive tract will slow down and function less efficiently. This lack of movement may lead to increased bowel irritability and constipation.
In addition, certain medications often prescribed for Parkinsons disease, such as anticholinergics, can cause constipation. Eating a balanced diet with plenty of vegetables, fruits, and whole grains is a good first step remedy.
Fresh produce and whole grains also contain a great deal of fiber, which can help prevent constipation. Fiber supplements and powders are also an option for those with Parkinsons.
Be sure to ask your doctor how to gradually add fiber powder to your diet. This will ensure you dont have too much too quickly and make constipation worse.
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If Levodopa Causes Dyskinesia Then Why Should I Take It
At present, treatment with levodopa is the most effective way to relieve tremor, stiffness, and slow movement associated with Parkinsons. In the early stage of Parkinsons, levodopa may not be necessary and there are other medications available to treat this stage of the disease. However, as the disease progresses and symptoms begin to interfere with daily living, your doctor will prescribe levodopa.
- It typically doesnt develop immediately Its important to note that there is usually a time lag of roughly 4 to 10 years from the start of treatment with levodopa to when dyskinesia emerges, and its severity will vary among different individuals.
- Younger people are at a greater risk People who get Parkinsons in their later years may not show signs of dyskinesia or may have only mild symptoms within their lifetime. Being diagnosed with Parkinsons at a younger age is associated with a greater chance of developing dyskinesia.
- As with every aspect of Parkinsons, there is variability in dyskinesias Some do not develop dyskinesias at all. For those who do get them, not all experience them the same. Dyskinesia in its milder form may not be bothersome, and the mobility afforded by taking levodopa may be preferable to the immobility associated with not taking levodopa. People with Parkinsons must weigh the benefits from using levodopa versus the impact of dyskinesia on their quality of life.
Dealing With Side Effects Of Parkinsons Drugs
Its important to speak to your specialist or pharmacist if you notice anything unusual.
Changing or adding to your medication might help, and your specialist will be able to look into this.
For many people with advanced Parkinsons, medication may start to be reduced if side effects outweigh the benefits of taking medication.
But if some of the medication is reduced, you may find you get the benefits of the remaining ones, rather than the side effects.
If you experience side effects from your Parkinsons medication, you shouldnt stop taking it without guidance from your specialist.
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Keep A Medicine And Symptoms Diary
Keeping a diary is a helpful way of monitoring your condition and keeping track of your medicines. A diary can be a useful way of letting your doctor know what problems youre experiencing, any changes in your condition from day to day or over a period of time, and how well your medicine is controlling your symptoms. It can also help remind you of things you want to discuss during your appointment that you may otherwise forget. You can also use it to record any embarrassing issues that you want help with but find difficult to ask about. Examples of diaries:
General Advice On Taking Oral Antiparkinsonian Drugs
- Drugs improve most patients quality of life and the activities of daily living, even though they cannot cure Parkinson’s disease nor prevent disease progression.
- Long-term use of antiparkinsonian drugs is usually necessary and abrupt withdrawal of the medication without medical supervision should be avoided.
- Good self-care can benefit patients enormously. Self-care includes things that you do to maintain good physical and mental health, prevent illness or accidents, and effectively deal with minor ailments and long-term conditions like having a balanced diet with regular exercise and adequate rest.
- Be familiar with the name and dosage of the antiparkinsonian drugs you are taking. Be cautious of their possible side effects.
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Types Of Dopamine Agonist Drugs
Below are the types of dopamine agonist drugs. The generic names are written in bold and the brand names are written underneath in bullet points.
Pramipexole
- Mirapexin prolonged release
- Pipexus
- Ralnea XL
- Requip
- Requip XL
- Spiroco XL
- Ipinnia XL
- Raponer XL
- Repinex XL
- Ropilynz XL
Rotigotine
- Apo-go pre-filled pen for Intermittent injection
- Dacepton cartridge for Intermittent injection
- Apo-go pre-filled syringe for infusion
- Dacepton Vial
Parkinsons And Decreased Range Of Movement
Exercise is important for everyone, but its especially important for people with Parkinsons disease. Physical therapy or exercise can help improve mobility, muscle tone, and range of motion.
Increasing and maintaining muscle strength may be helpful as muscle tone is lost. In some cases, muscle strength can act as a buffer, countering some of the other effects of Parkinsons. Additionally, massage can help you reduce muscle stress and relax.
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Take Your Parkinson’s Medications As Prescribed
Take your medications exactly as prescribed by your doctor in the right dose, and at the right time of day, and in the right way. You’ll be given instructions when you’re first prescribed a drug. Some medications are meant to be taken on an empty stomach, while others should be taken with food.
Parkinson’s patients who have trouble remembering when and in what dose to take their drugs can:
- Set a medication alarm on a smart phone, for instance. There are even special apps to remind you when to take your meds.
- Have their pills organized into a special medication box so they don’t have to think about what to take each time.
- Many pharmacies are able to put together “compliance medicine packages” that organize your drugs in a way that makes it easier to take them at the right time.
- When you take your meds, mark it off on a calendar.
- If necessary, a partner or carer can help you remember to take your drugs.
What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature and away from excess heat and moisture .
Store cassettes containing levodopa and carbidopa enteral suspension in the refrigerator in their original carton, protected from light. Do not freeze the suspension.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
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Common Drugs For Parkinson’s Disease
Levodopa and carbidopa . Levodopa is the most commonly prescribed medicine for Parkinsonâs. Itâs also the best at controlling the symptoms of the condition, particularly slow movements and stiff, rigid body parts.
Levodopa works when your brain cells change it into dopamine. Thatâs a chemical the brain uses to send signals that help you move your body. People with Parkinsonâs donât have enough dopamine in their brains to control their movements.
Sinemet is a mix of levodopa and another drug called carbidopa. Carbidopa makes the levodopa work better, so you can take less of it. That prevents many common side effects of levodopa, such as nausea, vomiting, and irregular heart rhythms.
Sinemet has the fewest short-term side effects, compared with other Parkinsonâs medications. But it does raise your odds for some long-term problems, such as involuntary movements. An inhalable powder form of levodopa and the tablet istradefylline have been approved for those experiencing OFF periods, OFF periods can happen when Parkinsonâs symptoms return during periods between scheduled doses of levodopa/carbidopa.
People who take levodopa for 3-5 years may eventually have restlessness, confusion, or unusual movements within a few hours of taking the medicine. Changes in the amount or timing of your dose will usually prevent these side effects.
Dopamine agonists. These drugs act like dopamine in the brain. They include pramipexole , rotigotine , and ropinirole , .
Treatments And Outcomes Of Dip
DIP is generally treated by cessation of the offending drugs. Patients who cannot stop taking antipsychotic drugs because of their psychiatric diseases, such as those with schizophrenia or major depressive disorders, may be switched to atypical antipsychotics that have a lower risk of EPS. People who are prescribed dopamine antagonists due to simple GI disturbance, headache, dizziness, or insomnia should stop taking the offending drugs as soon as possible. Anticholinergics including trihexyphenidyl, benztropine, amantadine, and levodopa have been empirically tested for their ability to relieve symptoms of DIP, but this has produced no clear evidence of their effects in DIP patients.,,,,
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Some Disadvantages Of Mao
When selegiline is taken together with levodopa, side effects such as dyskinesias , hallunications or vivid dreaming may sometimes occur or worsen.
When people have taken rasagiline on its own , the most commonly reported side effects have been:
- Headache
- Depression
When taken with levodopa, the most common reports have been of uncontrolled movements and accidental falls.
Many of these side effects may be due to the increase in dopamine caused by rasagiline or selegiline. Your doctor or consultant can alter the dosage to correct these effects.
If youre taking some types of antidepressant, you might not be able to take MAO-B inhibitors, as these drugs can interact with each other to raise blood pressure to a dangerous level.
Your neurologist or pharmacist is the best person to advise on potential interactions with other medications.
Dopaminergic Features And Their Treatment
Patients with PD usually present with features indicative of degeneration of nigrostriatal pathways. A useful clinical definition for PD is asymmetric onset of an akinetic rigid syndrome with resting tremor and a good response to levodopa. When applied by neurologists with an interest in movement disorders, this definition has a pathological correlation exceeding 98%. When treatment is considered appropriate, and this is a topic discussed in detail below, a variety of options is available. The use of dopaminergic drugs improves motor function, significantly reduces both the morbidity and mortality of PD, and improves quality of life.
Levodopa remains the drug most commonly used in PD. It is very effective in improving bradykinesia and rigidity, and in practice remains the gold standard against which other drugs are judged. Some studies, predominantly in vitro, have suggested that levodopa may be toxic. However, such data are conflicting, and some laboratory studies have suggested a growth factor-like effect for levodopa. Overall, the pre-clinical evidence for levodopa toxicity is not convincing and there are no data to indicate that any toxic action is of clinical relevance.
Table 1
Percentage of patients remaining on dopamine agonist monotherapy at years 14 and years 15 during treatment trials
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