Parkinson's Disease: A Caregiver's Guide to Medications

Chat Transcript: June 2000

"Parkinson's Disease: A Caregiver's Guide to Medications" with Dr. Sol Stern, M.D. This chat originally appeared on the Web of Care website in June 2000. Prism Innovations, Inc., the publisher of ElderCare Online and ALZwell.com recently added some of the resources from Web of Care after it went out of business. Be aware that medical practices may have changed since this chat was recorded, and this transcript is provided for educational purposes only. Consult with your health care provider if you have any questions.

Parkinson's Treatment

Dr. Stern noted that currently about 1 million Americans and Canadians suffer from the disease. Although about 15% of people with Parkinson's have a family history with it, no specific gene has yet been implicated. As a general comment, Dr. Stern said people with Parkinson's respond uniquely to different medications and dosages, and that often medications need to be adjusted as the patient ages.

"Although Parkinson's can progress over time, many people can be quite stable and lead full and productive lives while on treatment," he said.

Swallowing problems, or dysphagia, are quite common with progressive Parkinson's. Asked about medications to deal with this, Dr. Stern said they don't usually help, and advised "proper positioning and use of appropriate liquids and foods".

In the initial stages of PD, asked one participant, can fatigue be reduced with increasing doses of Sinemet CR? Dr. Stern says yes - "as long as side effects that come with increasing doses are acceptable". He also suggested combining Sinemet CR with Sinemet.

Asked what are the early signs of PD, and how long they usually exist before a diagnosis is made, Dr. Stern said increased public knowledge of PD means physicians are getting better at diagnosing the disease in early stages. Diagnosis, however, is still made by physical examination and exclusion of other neurological conditions. For example, an MRI brain scan eliminates the possibility of a brain tumor. "PD can't be diagnosed by a blood test or simple x-rays or CT scans," he added.

A caregiver to a 71-year-old woman with Parkinson's raised the issue of excess saliva. Benztropine Mesylate, or congentin, meant to reduce the saliva, had to be discontinued because of its impact on her dementia. Dr. Stern confirmed that this medication is not well tolerated by people over 70, but suggested a lower dose because the saliva issue, considered very difficult to treat, seemed extreme in this case.

Linda, age 58, reported she was recently diagnosed, after a year of tremors in left arm and chin. She has been on Sinemet for two months, and says she is "almost back to normal". Linda, who is otherwise in good health, wanted to know how long she can expect it to remain effective.

Dr. Stern said a patient of his on a similar dosage has been "stable for 7 years" and continues to exercise regularly and travel a lot. This patient is also on eldepryl to "slow the progression of the disease". He felt this level of stability is becoming more and more typical.

He recommended Linda ask her doctor about eldepryl, which is an MAO-Inhibitor. It can cause some digestive problems, but usually it is well tolerated.

Liz, whose husband was diagnosed several years ago at age 51, shared his medication history with the group: he has taken Sinemet CR for 5 years. He participated in a double-blind study for Tolcapone, and then it was removed from the market in the US and Canada. Then he took Mirapex for a year in addition to Sinemet CR but recently stopped the Mirapex to reduce medications.

Dr. Stern noted that Tolcapone was de-listed due to liver problems, and that Mirapex is called a "dopamine agonist" with an action similar to Tolcapone. It works like Sinemet but does not contain any L-dopa; side effects include drowsiness, constipation and hallucinations. Mirapex can be used with or without Sinemet.

Dr. Stern also noted that because Sinemet and Sinemet CR are absorbed through the intestine (and not the stomach) and they are best taken before meals, ideally more than 30 minutes before meals. This is because food will delay the ability of the medication to be absorbed into the bloodstream and thus make the medication less effective.

A diet high in protein may also interfere with the way Sinemet is absorbed into the brain as proteins may carry substances that prevent Sinemet from entering the brain.

Regarding natural products to help PD, Dr. Stern indicated that Vitamin E appeared to delay the mental deterioration seen in PD but anecdotally supplements like ginkgo biloba and Co-enzyme Q10 might offer some benefit as well.

Dr. Stern was asked about a PD patient having trouble with urinary incontinence and resulting odors. Dr. Stern advised the member that incontinence pads and adult diapers may help with the overall hygiene and odor and suggested that the caregiver talk to the primary care physician about the possible use of the prescription medication Detrol.

Caffeine and Parkinson's Disease

A recent study published in the New England Journal of Medicine (May, 2000) indicates that the caffeine in coffee may reduce the risk Parkinson's disease. It appears that the risk of getting Parkinson's is reduced by 5 times if one consumes 28 oz or more of coffee a day. The significance of this study is not known yet and the reason that coffee drinkers have a lower risk of Parkinson's disease is also not clearly understood.

This study parallels a recent Dutch study that suggested that another (so-called) habit - smoking cigarettes - also reduces the risk of getting Parkinson's disease. Although it is unlikely that physicians will start recommending their patients to start drinking more coffee and smoking cigarettes to decrease their risk of the disease, these studies do shed light on the fact that certain lifestyles increase the risk of some diseases but reduce the risks of others. 

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