Medication for Parkinson’s Disease

This week we’ll look at commonly prescribed medication for a neurodegenerative disorder called Parkinson’s Disease (PD). We’ll deep dive into Parkinson’s itself another time, but briefly it is a brain disorder that leads to difficulty with movement and potentially to cognitive and emotional difficulties. In fact, there is a dementia subtype called Parkinson’s dementia.

The (very) basic problem in Parkinson’s is that nerve cells in a part of the brain that helps control movement become defective and/or die. These cells are responsible for dopamine production, and when the dopamine decreases in this specific part of the brain we start to see Parkinson’s symptoms. With this in mind, the (very) basic treatment in PD is to replace this dopamine.

It can be difficult to decide when to start medication for PD, but usually this occurs when the disease starts to affect a person’s day to day life. Medication doesn’t always need to start when the diagnosis is made, but a frank conversation should be had with the person experiencing the symptoms about:

• When they would want to initiate medication?

• What goals would they want to be able to achieve with medication initiation?

• What side effects are they willing to have from the medication?

Briefly, the most frequently prescribed medications are called Carbidopa-Levodopa, Pramipexole, Ropinirole, and Rotigotine. The first one (Carbidopa-Levodopa) is a “dopamine precursor,” meaning our body turns it into dopamine. The last three are “dopamine agonists,” meaning they just substitute themselves for dopamine. Both classes have different side effects, which are fairly similar. In older adults, concerning side effects are confusion, hallucinations, and something called orthostatic hypotension. This means a person’s blood pressure inappropriately decreases when they change positions, particularly going from lying down to sitting or standing and can put a person at higher risk for falling.

Regarding medications for PD, I am fortunate to practice medicine in a “resource-rich” area, meaning there are plenty of experienced neurologists around to help patients select medications, as well as occupational, physical, and speech therapists to help patients overcome the day to day challenges of living with PD. Many people do not have this luxury, so I hope this provides a basic resource to start a conversation with your primary care physician about What Matters regarding your medications.

Key Points:

• The basic problem in Parkinson’s Disease is a decreasing amount of dopamine in a specific part of the brain

• The basic treatment in Parkinson’s Disease is finding a way to increase dopamine in that part of the brain

• Balancing medications with What Matters is critical to a person’s quality of life