Over the years things change and fashions come and go.
When I started out as a Parkinson’s nurse over 20 years ago, the received wisdom was to delay treatment until it was difficult to do daily tasks. The idea was that as the medication only worked for a number of years, it would be better to delay taking it for as long as possible. We now know that this is not the case and people with Parkinson’s respond to treatment for decades.
So far, no agent or medication has been found to slow the loss of dopamine-producing cells and by the time of diagnosis you have lost about 60-70% of these cells. The remaining dopamine-producing cells convert levodopa (Sinemet, Madopar) to dopamine and the dopamine receptor sites are switched on by dopamine agonists (ropinirole, pramipexole). A 50%-90% improvement in symptoms in the first years of having Parkinson’s means that function can be restored to almost normal and that can allow for regular exercise, something that is looking increasingly likely to slow the progression of the condition.
As Parkinson’s progresses, there are fewer dopamine-producing cells and receptor sites to service the medication and so the strength and frequency of the medication needs to increase to compensate. Therefore, there is no advantage in managing on lower doses than you need, because you cannot save it for later.
The best approach is to be optimally treated at every stage of Parkinson’s. This allows you to keep active and exercise, which should have an impact on the progression of Parkinson’s.
Read the entire collection of articles from Liz since she started writing for us in 2010.