Long-term treatment

Parkinson’s disease (PD) is a long-term neurological condition involving mild symptoms that progress, over a period of years, to more severe symptoms. Therefore, treatment plans must take into consideration the fact that people are likely to be treated for PD for more than 15 years.

In the early stages of PD, a single dopaminergic medication (most commonly levodopa, an MAO-B inhibitor, or a dopamine agonist) is usually a sufficient treatment. As PD progresses, most people will need a combination of various medications, including levodopa. Early medications, e.g., MAO-B inhibitors, do not need to be discontinued when levodopa treatment is started.

In later disease, once the effects of levodopa start to wear off, become unpredictable, or produce dyskinesias (restless movements), MAO-B inhibitors, dopamine agonists, or COMT inhibitors can be added to the treatment schedule to control these complications (see Figure, below). If the person with PD experiences problems with thought and memory, depression, or hallucinations/psychosis, then cholinesterase inhibitors, antidepressants, or antipsychotic medications may be prescribed, respectively.

In addition to therapy with medications, there are other ways in which people with PD can manage the condition, and improve their overall well-being in the long term. These options are described in more detail in the ‘Complementary/alternative treatments’ section. Consequently, it is often difficult to determine the precise effects of any long-term treatment for PD, as the person may also be receiving other types of therapy.

Long-term management of PD

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