Parkinson's
Patient Education

Doctors Who Treat Parkinson’s Disease

As your Parkinson’s disease is diagnosed, treated and managed, you may encounter the following team of doctors and specialists listed in this Parkinson’s patient education guide.

• Neurologist - A doctor who specializes in disorders of the brain and nervous system. Neurologists diagnose and treat patients with Parkinson’s disease and supervise their ongoing treatment.
• Movement Disorder Specialist - A neurologist with experience and specific training in assessing and treating movement disorders, including Parkinson’s disease. These doctors diagnose and treat patients with Parkinson’s disease and supervise their ongoing treatment.
• Internist or Family Physician - Doctors who provide general medical care for adults. Adults with Parkinson’s disease may initially be diagnosed by an internist or family physician, who may continue to monitor the patient in concert with a neurologist.
• Geriatrician - A doctor who specializes in the medical care of elderly adults. Elderly adults with Parkinson’s disease may initially be diagnosed by a geriatrician, who may continue to monitor the patient in concert with a neurologist.

How to Prepare for Your Parkinson's Disease Doctor Visit

Having made your appointment with a healthcare provider, there are certain actions you can take to maximize the benefit of your doctor visit which are outlined in this Parkinson's patient education guide:

• Write down a list of symptoms, including any that may seem unrelated to Parkinson's disease, and when they tend to occur.
• Make a list of all medications, vitamins and supplements that you're taking. Include the dosage you are taking of each.
• Write down key personal information, including prior illnesses, diet and exercise habits, type of work that you do, and any major stresses or recent life changes.
• If you are going to a neurologist, obtain a copy of your medical records and bring them to the appointment or ask your regular doctor to forward a copy to the neurologist.
• Write down a list of questions you have for the doctor so that you don’t forget to ask any of them. If possible, bring a family member or close friend who can help you remember everything you and the doctor discuss.
• Be prepared to answer many questions and to take an active role in managing your disease. Parkinson's disease requires ongoing medical care and active participation by patients

Questions to Ask Your Doctor About Parkinson's Disease

From your initial diagnosis throughout your treatment and care, you will have questions about your condition. This Parkinson's patient education guide lists questions to discuss with your doctor so you can make informed decisions about your condition and your care.

Below is a list of helpful questions for each trimester of your pregnancy.

Question About My Diagnosis

• What causes Parkinson's disease?
• How is Parkinson's disease diagnosed?
• Will my symptoms get worse? If so, how fast will they worsen?
• Will I become completely disabled?
• Will I die from Parkinson's disease?

Questions About My Treatment

• What diet should I follow?
• What foods should I avoid?
• How much weight should I gain?
• What exercise can I do? What should I avoid?
• Are there any foods or medications that I should avoid?
• Is it safe to have sex?

Questions About My Diagnosis

• Will I need to see a specialist for treatment? Will insurance pay for this?
• What type of medication is used to treat Parkinson's disease? Are there side effects?
• Will other medications I take interact with my Parkinson’s medication?
• Are there any surgeries to treat Parkinson's disease?
• Will physical therapy help me maintain physical function?
• Are there alternative or complementary therapies that may help manage my symptoms?

Questions About My Lifestyle & Family

• Do I need to make any changes to my diet or daily routines?
• Will exercise help my symptoms?
• Are there certain jobs or activities I cannot do because I have Parkinson's disease?
• Do motor symptoms like tremor and slowness of movement mean I cannot drive a car?
• Is there a support group in my area for people with Parkinson's disease and their families?
• Do I need to make plans for complete disability?

Common Tests or Labs to Diagnose Parkinson's Disease

Currently, there are no laboratory or imaging tests to diagnose Parkinson's disease. Doctors diagnose the disease by asking many questions about your medical history and performing physical and neurological exams (described in the table below) to look for one or more of the most common motor symptoms (listed below) as well as other secondary and nonmotor symptoms.

• Trembling of the hands, arms, legs, jaw, or head (also called tremor)
• Stiffness of the limbs and trunk (also called rigidity)
• Slowness of movement (also called bradykinesia)
• Impaired balance (also called postural instability)

Diagnosis of Parkinson's disease is particularly challenging because the initial signs can seem like signs of normal aging and because the symptoms of Parkinson's disease can be present in several other disorders, including a number of parkinsonian disorders that are different from Parkinson's disease. Doctors may order imaging tests (described in the table below) to rule out other diseases. But since the CT and MRI brain scans of people with Parkinson's disease usually appear normal, these tests do not diagnose the disease.

Test	Why Test?	What Happens?	Normal Result
Neurological exam	To check how well the brain and nervous system are functioning	A doctor performs physical tests and observes a patient performing physical and mental tasks.	The doctor is looking for any problems with functioning of muscles, senses, reflexes, memory or simple mental tasks, as well as trouble with walking or coordination.
Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) Scans	To view the structures of the brain	A patient lies on a table that slides inside a large machine. Dye may be injected by syringe into the veins to help make clearer images.	Abnormal findings, such as brain tumors or structural abnormalities, may be the cause of symptoms.

In addition to diagnosis, doctors determine the stage of disease and use staging systems to track the progression of symptoms over time. The Hoehn and Yahr Scale (shown below) and the Unified Parkinsons Disease Rating Scale (UPDRS) are two such staging systems. The UPDRS is a more complicated scale with multiple ratings that measure mental functioning, behavior, and mood; activities of daily living; and motor function.

Hoehn and Yahr Staging of Parkinson's Disease

Stage	Symptoms
Stage 1	Symptoms on one side of the body only
Stage 2	Symptoms on both sides of the body; No impairment of balance
Stage 3	Balance impairment; Mild to moderate disease; Physically independent
Stage 4	Severe disability, but still able to walk or stand unassisted/p>
Stage 5	Wheelchair-bound or bedridden unless assisted

Common Medications and Treatments for Parkinson’s disease

Currently, there are no treatments that cure Parkinson's disease. Medications are used to treat Parkinson’s symptoms, primarily by increasing or maintaining the levels of dopamine in the brain. However, these drugs do not stop the progression of the disease and their effectiveness diminishes over time.

This Parkinson's patient education guide describes the common medications used to treat the motor symptoms of Parkinson's disease. Doctors may also prescribe other medicines to treat nonmotor symptoms, such as depression, anxiety, and low blood pressure.

Drug Category	How it Works
Dopaminergics	Levodopa (L-dopa), the cornerstone of Parkinson’s disease treatment, increases brain levels of dopamine because nerve cells can use levodopa to make dopamine. Levodopa reduces tremors, rigidity and slowness of movement. Carbidopa is very often combined with levodopa to enhance levodopa’s effects and reduce some of the side effects, such as nausea and vomiting. At high doses and/or after long periods of taking levodopa, many patients develop dyskinesias, which are involuntary movements such as twitching, twisting, and writhing.
Dopamine agonists	These drugs reduce symptoms by mimicking dopamine in the body.
Monoamine oxidase B (MAO-B) inhibitors	These drugs inhibit the enzyme MAO-B, which breaks down dopamine in the brain. They cause dopamine to build up in the surviving nerve cells.
Catechol-O-methyltransferase (COMT) inhibitors	This antiviral drug helps reduce Parkinson’s symptoms possibly by increasing the effects of levodopa.
Anticholinergics	These drugs work by decreasing the activity of the brain chemical acetylcholine, which is another way to help to reduce tremors and muscle rigidity.
Note: These medications can interact with foods, other medications, vitamins, herbal supplements, over-the-counter cold medicines and other remedies. Anyone taking these medications should talk to their doctor and pharmacist about potential drug interactions.

Surgery may be performed for people in whom drug therapy is no longer effective.

Type of Surgery	How it Works
Deep brain stimulation (DBS)	In DBS, electrodes are surgically implanted into an area of the brain and a small electrical device (called a pulse generator) is implanted beneath the collarbone. The electrodes are connected to the pulse generator by a wire under the skin. The pulse generator and electrodes painlessly stimulate the brain to stop many Parkinson’s disease symptoms. When DBS is effective, patients don’t need to take as much levodopa or other drugs, which typically reduces dyskinesias associated with levodopa.
Pallidotomy and Thalamotomy	These surgeries work by destroying specific parts of the brain that contribute to Parkinson’s symptoms. Because they permanently destroy brain tissue, these surgeries have largely been replaced by DBS. Pallidotomy, the more common of the two, can improve symptoms of tremor, rigidity, slowness of movement, and gait, as well as reduce the amount of levodopa needed to control symptoms. Thalamotomy is used primarily to reduce tremor.

Complementary and Supportive Therapies

• Physical, occupational, and speech therapy may help with:
  • Gait and voice disorders
  • Tremors and rigidity
  • Cognitive decline
• Dietary therapy:
  • Although research on potential benefits of various vitamins and nutrients is ongoing, none has yet been proven effective for treating Parkinson's disease or slowing disease progression.
  • A diet high in fiber and plenty of fluids can help alleviate constipation.
  • A high-protein diet should be avoided because it may limit the effectiveness of levodopa.
• Exercise may have the following benefits::
  • Improved mobility, flexibility, balance and gait
  • Increased muscle strength to reduce overall disability and improve speaking and swallowing
  • Improved emotional well-being, potentially by improving the brain's dopamine synthesis or increase levels of other beneficial brain chemicals
• Some patients find massage therapy, yoga, tai chi, acupuncture, or the Alexander technique (a technique to optimize posture and muscle activity) helpful, though there is no evidence that these have an effect on symptoms.