Exercising With Parkinson’s Disease

Exercising With Parkinson’s Disease


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A Guide to Being Physically Active With Parkinson’s



Research has shown that regular exercise benefits people with Parkinson’s disease


  • reduces stiffness
  • improves mobility, posture, balance and gait

Aerobic exercise increases oxygen delivery and neurotransmitters to keep our heart, lungs, and nervous system healthy. General exercise may also reduce depression. Learning-based memory exercises can also help keep our memory sharp.



Best Exercise Options for People with Parkinson’s Disease


There is increasing evidence that aerobic and learning-based exercises could be neuroprotective in aging individuals and those with neurodegenerative disease.  

Facilitating exercise programs that challenge our heart and lungs as well as promote good biomechanics, good posture, trunk rotation and normal rhythmic, symmetric movements are the best.  Dancing to music may be particularly good for decreasing stiffness.

Although research on this subject is ongoing, it does appear that beyond aerobic activities performed with healthy movement patterns, exercises challenging the individual to change tempo, activity, or direction (what is referred to as “random practice” exercise) benefits people with Parkinson’s disease. 

It is also important to keep variety in exercise activities, because individuals with Parkinson’s disease often have difficulty in shifting from one activity to another or in performing two activities at the same time. Exercises that require balance and preparatory adjustment of the body are also important along with rhythmic activities such as dancing, skipping and cycling can maintain the ability to perform reciprocal movements.   Finally, exercises that promote attention and learning are beneficial.


Types of exercises that do this:

  • Walking outside or in a mall
  • Dancing
  • Yoga classes
  • Tai Chi classes
  • Stepping over obstacles
  • Marching to music with big arm swings
  • Sports (ping pong, golf, tennis, volleyball)
  • Aerobic/Jazzercise classes  


Types of exercises that promote cardiopulmonary fitness:

  • Paced walking (treadmill walking at different speeds and different inclines)
  • Hiking using walking sticks
  • Swimming with different strokes with the eyes open and closed not only challenge motor learning but also increase heart rate and provide good cardiopulmonary conditioning.


Types of exercise that do NOT challenge motor planning:

  • Riding a stationary bicycle without doing other activities
  • Weight lifting
  • Treadmill walking at a slow speed
  • Lap swimming can be very habitual and also automatic.  


These exercises for cardiovascular, endurance and strengthening could be enriched by performing simultaneous activities such as reading, writing, problem solving, singing, watching the news or a movie or throwing and catching balls. Exercises that demand attention, repetition, progression of difficulty with spaced practice over time are the best exercise routines to promote learning.

A note on bicycling: Parkinson’s disease impairs balance and reaction time. Traditional bicycles may pose a safety risk for some patients. Stationary, tandem and three-wheeled bikes are safe alternatives.


Example: Sunny Health Recumbent Bike (300 lb capacity)



Parkinson’s Study Shows a Specific Type of Treadmill Exercise Improves Walking in Patients With Parkinson’s


Researchers from the University of Maryland School of Medicine and the Baltimore VA Medical Center found that Parkinson’s patients who walked on a treadmill at a comfortable speed for a longer duration—what’s considered a low-intensity exercise— improved their walking more than patients who walked for less time but at an increased speed and incline, a high-intensity exercise. They also found benefits for stretching and resistance exercises.

“Our study showed that low-intensity exercise performed for 50 minutes three times a week was the most beneficial in terms of helping participants improve their mobility,” says Lisa Shulman, MD, principal investigator and professor of neurology at the University of Maryland School of Medicine. “Walking difficulty is the major cause of disability in Parkinson’s disease. These results show that exercise in people with Parkinson’s disease can make a difference in their function. Exercise may, in fact, delay disability and help to preserve independence.

“Many patients ask us what kind of exercise they should be doing. Now we can tell them that this research shows that low-intensity walking, which most people with Parkinson’s can do, combined with stretching and resistance training may be the best option,” adds Dr. Shulman, who is also co-director of the Maryland Parkinson’s Disease and Movement Disorders Center at the University of Maryland Medical Center.

The study compared 67 people with Parkinson’s disease who were randomly assigned to one of three exercise groups: walking on a treadmill at low intensity for 50 minutes, higher-intensity treadmill training to improve cardiovascular fitness for 30 minutes, and using weights (leg presses, extensions and curls) and stretching exercises to improve muscle strength and range of motion. Participants exercised three times a week for three months under the supervision of exercise physiologists at the Baltimore VA Medical Center. “We saw positive effects with all three types of exercise, but the low-intensity training showed the most consistent improvement in gait and mobility,” says Dr. Shulman.

“To maintain the best possible quality of life, people with Parkinson’s disease need practical, evidence-based advice about what kind of exercise will most benefit them over the long term. The Michael J. Fox Foundation has aimed to answer this question in its exercise funding to investigators such as Dr. Lisa Shulman and her team,” says Todd Sherer, PhD, chief program officer of The Michael J. Fox Foundation for Parkinson’s Research.

The Maryland research team measured participants’ cardiovascular fitness before and after training, and found cardiovascular improvement in both the low- and high-intensity groups. Other measurements included the distance covered in a six-minute walk and timed tests of walking short distances, such as 50 feet.

“The results of this study provide practical information to people with Parkinson’s disease to make decisions about managing their health and well-being. Our University of Maryland faculty members are committed to testing new approaches, such as exercise, to help patients,” says E. Albert Reece, MD, PhD, MBA, vice president for medical affairs, University of Maryland, and dean, University of Maryland School of Medicine.


This Exerpeutic F2000 Recovery Fitness Walking Treadmill with Full Length Hand Rails is specifically designed for seniors and people in recovery.



Avoid Strength Training

Weight lifting is NOT the best choice of an exercise program for the person with Parkinson’s disease, particularly if it is the only exercise activity.  Individuals need to be careful how they perform strengthening exercises to minimize increasing stiffness and rigidity. When performed properly, strengthening exercises do have some value.

As one ages, more exercise must be performed to maintain muscle mass.  Muscle mass and strength allow an individual to complete daily chores and to maintain balance.  Additionally, strengthening postural muscles may help to maintain a more upright posture. Integrative, functional exercises other than weight-training may strengthen muscles in ways that are more beneficial to individuals with Parkinson’s disease.


Examples of alternative exercises to weight lifting:

  • Activities in a standing position strengthen legs
  • Pushing up to rise on the toes
  • Modified squats
  • Repetitively rising and sitting from a chair
  • Wearing ankle and wrist weights around the house or out on a walk
  • Push-ups or wall push-ups for arms


Light weights are just as effective as heavy weights in maintaining muscle tone and do not increase stiffness as much.  Walking with ankle weights and wrist weights can help strengthen while encouraging increased awareness of arm swinging and high stepping.

Example: These Nordic Lifting 5 lb Ankle/Wrist Weights are fully adjustable to fit anyone, and can be used on either the ankles or wrists.


Moderation is the best word for strength training without other forms of exercise. However, integrating strengthening and flexibility exercises into aerobic, rhythmic and learning-based exercise routines that are fun, engaging, progressing in difficulty and rewarding are the best.


Swimming is a Good Second Choice Activity

Swimming provides good cardiopulmonary training and maintains muscle strength.  However, lap swimming does not challenge balance or stimulate variety of movements.  Therefore, lap swimming is a second choice activity. However, since the arms, legs and head may be doing different things, it may increase coordination.  The resistance of the water increases stiffness in some people and decreases it in others.


Activities to try:

  • Adding resistance with paddles and trunk support – provides more opportunity for reciprocal movements and circling movements of the arms and the legs
  • Rolling and somersaults – in the pool are good for those who are particularly comfortable in the water


A Caution About Swimming

For individuals with Parkinson’s disease who have difficulty in breathing, swimming may not be a comfortable aerobic activity. Thus, swimming may be an appropriate choice of exercise for individuals who have enjoyed it in the past and are comfortable with the techniques and those with musculoskeletal conditions particularly of the knee and back. Swimming using certain strokes can also help increase shoulder range of motion.


Decreasing Muscle Stiffness With Specific Exercises

Exercises that require large, rhythmical movements through a full range of motion have been shown to decrease rigidity.  For example, in a program of aerobic exercise using music, there was a reduction in rigidity in 9 out of 10 participants immediately after the exercise program.


Exercises to decrease stiffness:

  • Large, rhythmical movements
  • Rotating the trunk
  • Vibration, rocking and swinging


Other considerations to decrease stiffness:

  • Avoiding tremors (e.g. touching the limb that is shaking to quiet the movement) can also decrease tension 
  • Decreasing stress in ones life – having fun, thinking positively about planning and carrying out challenging, socially engaging and learning-based activities
  • Cooling or warming the tense extremity can sometimes be helpful.


The Effect of Medication on Exercise

The best time to exercise is when mobility is best. For individuals who take medications for Parkinson’s disease, the best level of function often occurs about 1 hour after a dose of medications.  The answer to this question varies by individual. The individual reaction to the medication is also important.


Frequency of Exercise

The guidelines for people with Parkinson’s disease are no different from those without the disease (i.e. 4-5 times a week for at least 30-40 minutes).  This assumes that your heart is beating at 70 to 80% of maximum (220 – your age times 70 or 80%).


Make Exercise Fun:

Engage in group exercise, movement or dancing classes.  For many, participating in activities with other people, can be more stimulating and increase compliance.


Stay active and integrate exercise into your usual day:

  • Walk whenever possible instead of driving
  • Climb the stairs instead of taking the elevator
  • Take regular 5 minute breaks every 30 minutes (lifting the arms up over your head, performing wall glides, breathing diaphragmatically, getting up to get a glass of water, or putting theraband exercise bands on chairs to work on some strengthening)
  • Avoid long periods of time watching TV and or using a computer


Example: These exercise bands are a great way to gently work muscles at home.


They come in 5 strengths, and can be used for a variety of exercises.







Cool Down After Exercise

A “cool-down period” is important.  After exercise, allow yourself a longer time for a cool-down than others would need (Individuals who exercised before developing Parkinson’s disease typically double their cool-down time).  


A cool-down period accomplishes 2 goals:

1)      Promotes a slow decrease in heart rate

2)      Allows the muscles time to cool down gradually so they do not become stiff.  

A cool-down period consists of the same exercise activity but at a progressively slower pace.  During the cool-down, all muscles need to go through a slow, full range of motion.  If you feel exhausted and want to fall asleep immediately after exercise, then you are not cooling down slowly enough.


Daily Learning

If you listen to the news, talk to someone about it.  Listen to educational programs and discuss what you learned.  Do crossword puzzles or participate in memory training programs on the web or from a CD.


Getting Out Regularly

If you are retired, consider volunteering your time to help others ( e.g. Red Cross, Meals on Wheels).  Move about in the community and learn the tricks of keeping your eyes on a target to improve stability. Carry a cane to let people know that it would be best not to bump you.

See Choosing a Walking Cane


Practice Writing

Learn to hold your pen lightly and write with big cursive type movements. Consider making the surface of your pen rough or sticky. This will help decrease the force of your squeezing the pen. Write by moving the whole arm, not just the fingers.  Practice writing to music and even say the words out loud as you write. Circle making big movements.


Your Voice Needs Exercise, Too

Talk slowly, clearly and loudly with a lot of expression of your eyes and your face. Have everyone speak loudly and slowly. If you find you continue to talk softly and quickly and people are having difficulty understanding you, then ask a friend to read and record some passages from a book. Then you put the head set on and hear your friends voice as you read the same passages.  This may strengthen the learning.



Helpful Walking Techniques

Often individuals with Parkinson’s disease have problems with abruptly halting or “freezing,” when walking.


To help decrease freezing, try:

  • Reciprocal arm swinging
  • High long steps
  • Scanning the environment and using visual fixation on an object in the distance or auditory cues (listening to music, singing to yourself, counting)
  • Thinking about making big steps to clear obstacles on the floor or marching (high steps)
  • Walking hand-in-hand, swinging the arms with a friend or family member
  • Having someone place their foot in front of you as a cue to step high and over
  • One person found that throwing pennies and stepping over them was helpful (“But,” he added, “don’t bend down to pick them up.”). 
  • Loud rhythmical clapping
  • Paced walking with high stepping. 
  • Using walking sticks (using them for sensory feedback and sense of stability may be more important than using a cane. Of course, using a cane or a walker can be helpful if there is a lot of weakness and stiffness.) 

Pushing one’s self to stay active should be the goal.


See Choosing the Right Medical Walker



Getting Out of Bed

For some people with Parkinson’s disease, getting out of bed may become difficult. First, you might practice rolling on your bed. Roll back and forth and get a rhythm. Then with some momentum, roll to your side and come to sitting. You might have a dresser near the side of your bed so you could touch the dresser for stability if you need to.

When specifically trying to come to sitting from lying in bed, roll over on your side. Push on your elbow and let your feet come over the edge of the bed and then sit up at the edge.  Sit there for a minute to adjust and then rise to stand and then walk. This technique is not only easier but better for your back.


This Stander Bed Cane can provide much needed support for getting out of bed.



Techniques to make it easier to move around in bed:

  • Wear satin pajamas or use satin sheets (but not both). 
  • Practice standing up and sitting down quickly from a chair without using your hands, to improve your transitional movement skills
  • Practice getting up quickly from a chair and taking a few big steps and then turn around and go sit back down. 
  • Practice safe skills by climbing and descending stairs.  

If you are seeing a physical therapist, the last three bullets are some of the activities that should be practiced.




Final Thoughts

Exercise is a vital part of daily life for all people who want to stay fit and healthy. For people with Parkinson’s disease, however, it is more than just about staying healthy. For them, the right exercises can improve vital aspects of daily living, such as mobility and maintaining balance. Those with Parkinson’s Disease should speak with their doctor or an advisory group to work out a specific program to help them start or maintain an exercise program.



Thanks for visiting and reading …

I hope this article provided you some helpful ideas.  I welcome your comments below.





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Have You Heard of Weighted Blanket Therapy?

Have You Heard of Weighted Blanket Therapy?





The drug-free therapeutic blanket known as weighted blankets have become the at-home treatment for insomnia, anxiety, autism spectrum disorders (ASD), attention-deficit hyperactive disorders (ADHD), Restless Leg Syndrome (RLS), Asperger’s and sensory disorders.


Many seniors, adults, teenagers and children face psychiatric issues that cause insomnia and severe anxiety. Patients with autism and other psychiatric disorders also face extreme anxiousness and the inability to induce calmness within themselves without the use of sedatives or drugs. Image above: YnM Weighted Blanket.


The combination of behavioral aberrations, and the lack of sleep among these people, have been known to lead to loss of productivity in their daily lives, irrational emotional behavior and out – of – character actions. It isn’t just the problem of not being able to keep their emotions under control, but the issue of lashing out aggressively due to psychological dysfunctions.


The root causes of such behavioral issues are anxiety and insomnia, which is usually treated with pharmacological (drugs) and psychological (therapy) methods. However, now with a breakthrough in the study of sleep medicine and psychiatric disorders, we know that the trick to soothing consternation and inducing sleep is much simpler than once thought.


The drug-free therapeutic blanket known as weighted blankets have become the at-home treatment for insomnia, anxiety, autism spectrum disorders (ASD), attention-deficit hyperactive disorders (ADHD), Restless Leg Syndrome (RLS), Asperger’s and sensory disorders.


Weighted blankets use deep pressure touch simulation (DPTS) to relax the body and make the patient feel safe, guarded and secure, which calms their unease and helps their body go to sleep. The sensory compression methodology facilitates a positive change with the comfort the blanket brings to its user. The weight of the blanket stimulates the receptors on your body which then activates the neurotransmitters in your brain to bring a sense of happiness to the person.



The Poly plastic (Polypropylene) pellets that have been used to fill the compartments of the blanket provide the weightage of the blanket. A quality weighted blanket is quilted, made of either cotton or fleece and weighs about 10% of the user’s body. Using the proper blanket according to the size and the weight of the user will give the optimum calming results.


This blanket has shown to be very effective in calming hyperactive children during bedtime, anxious patients in therapy and even adults undergoing chemotherapy. It has also proven to be efficacious in calming people down during anxiety inducing situations.



Studies Prove the Benefits of Weighted Blankets


– A 2008 study showed that weighted blankets are beneficial for anxiety. The study used a 30 lb. blankets on adults. In total, 63% reported a decrease in anxiety, and 78% found it calming.

– A 2015 study used 30 pound blanket on adults during an inpatient mental health hospitalization. 60% of them reported significant decrease in anxiety after use.

– Research on DPTS started as early as the 1950s. One article from 1992 found great benefits of this therapy for patients with autism. It reduces self-harming behaviors in autistic children, as well as produced better sleep. It also relaxes the muscles.

One adult autistic patient has stated, “I need heavy blankets on me to sleep well, or else my muscles won’t calm down.” 

– Weighted blanket were also found to be very calming for babies.



Therapeutic Benefits of Weighted Blankets





1. Weighted Blankets Promote Sleep


Insomnia is a sleep disorder that causes habitual sleeplessness. The lack of sleep leads to the over exhaustion of the human body and hampers the psychological well-being of the person. When a person is not able to function well, both physically and mentally, their social well being is affected and they begin to lose productivity in their lives. This leads to depression and other behavioral problems.

An easy solution to this problem is the weighted blanket. The pressure of the weighted blanket reaches deep within the body of the user to provide a comfortable environment for a person to fall asleep in. The sense of being swaddled and the physical connection that the user feels with the blanket makes them feel warm and safe. This helps their mind be at ease and they can be able to relax their body. The state of tranquility will help clear their mind and ensure a good night’s sleep.

According to the ‘Positive effects of a weighted blanket on insomnia’ by the Journal of Sleep Medicine and Disorders 2015 of the SciMed Central, the weighted blankets had improved the sleep quality of people with severe insomnia.



2. Weighted Blankets Imitate a Warm Hug


Research shows that hugs can actually make a person feel at ease. Hugging a person releases the hormone Oxytocin into the blood stream. This chemical reduces your blood pressure, calms your heart rate and provides and overall feeling of relaxation.

Although the blanket does not provide a human connection, your body may perceive the warmth and security the imitation that a hug provides. Both the hug and the blanket use a gentle yet firm pressure that goes deep within the person’s body tissues. This gives the user a sense of repose and allows your body to relax.



3. Weighted Blankets Provide a Sense of Security


Being covered by a weighted and warm blanket will ensure the feeling of calmness in the user. The ‘blanket therapy’ stimulates the receptors present throughout our body, which lessens a person’s discomfort. Once the user feels more comfortable in the blanket, they begin to feel secure as their body begins to relax. The body can only relax when your mind is soothed and your heart rate is calmed. This change in the body will ensure that both your body and mind believes that you are secure and safe.



4. Weighted Blankets Increase the Production of Serotonin


Serotonin is a chemical messenger, also known as a neurotransmitter that your brain and intestines produce for the smooth functioning of your nervous system, which includes the brain and the nerves. This hormone is secreted to promote happiness and the mood of the people. Known as the ‘happy hormone’, this chemical does not only affect a person’s mood but it affects their behavior. The lack of serotonin in the body leads to depression, insomnia and anxiety. That is why the sensory stimulating weighted blankets increase the production of serotonin in the body. The hormone relaxes your body and makes you feel calmer. That sense of calmness leads to pacifying one’s anxiety, which results to inducing sleep in the user.



5. Weighted Blankets Increase the Production of Melatonin


Melatonin, also known as the ‘sleep hormone’ is a chemical that affects a person’s sleep. The hormone is produced with the production of serotonin, as well as the pineal gland in the brain. This chemical is known to ease insomnia and induce sleep, which is possible through the therapeutic benefits of the weighted blankets that provide a gentle yet firm pressure on your body by stimulating your receptors.




6. Weighted Blankets Calm Patients with Autism Spectrum Disorder


Autism spectrum disorder includes Asperger’s, Autism, Rhett Syndrome and other unspecified Pervasive Development Disorders. Such disorders include behavioral problems that do not necessarily bode well with the norms of society. The patients suffering from such disorders feel aggression and irritation due to the inability to express or convey their thoughts clearly. Such slow cognitive development makes the patient unable to process information quickly and the change in their surroundings.


Patients with such disorders are not able to communicate properly, so they use erratic speech, repetitive actions and turbulent behaviors. During a frustrated outburst, the patient’s heart rate increases, their breath becomes shallow and their blood pressure rises – which further increases their irritability.


When the patient is going through such tempestuous emotions and tantrums, it is best to drape the weighted blanket around them or have them lay down with the blanket covering them. This will make them feel more relaxed and comfortable. Once they are no longer acting in a hysterical manner, they will be able to think with a clearer mind and a calmer body. Although communicating with their caretakers might still be difficult, there will at least be an opportunity for the patient to gather more patience and attempt to convey their thoughts in a more serene manner.



7. Weighted Blankets Help Overcome the Oversensitivity to Touch


Some psychiatric disorders make people oversensitive to touch. Patients with Autism Spectrum Disorders usually face such discomfort with the touch of other people but this can be overcome by introducing the weight of the blanket regularly to the affected patient.


The pressure of the blanket provides a similar feeling of human touch at a larger scale without actual connection – which can be a stepping stone in helping patients overcome their fear of touch.


During the 1990s, a squeeze machine was used to help patients overcome their oversensitivity to touch. Today, with the inception of the ‘therapy blankets’, patients can use the more accessible and less controversial mechanism to help people become more at ease with touch.



8. Weighted Blankets Pacify Obsessive Compulsive Disorder


Obsessive Compulsive Disorder or OCD drives a person to think repetitively about a certain incident or an object. Such thoughts constantly play across a person’s mind and lead them to neglect their duties and their personal lives. The patient becomes anxious about a particular event and conducts a certain action over and over again. Their thoughts are occupied and their bodies refuse to break out of an obsessive reverie.

A very effective way to ease an OCD patient’s anxiety, and to treat the inability to calm them down from a mind consuming thought is to use a weighted blanket. This blanket allows the patient to feel safe and secure without worrying about the numerous issues that may be present in their lives. The blanket provides a warm environment for the user by helping to relive stress and allow their mind to release the captivating thoughts.



9. Weighted Blankets Mimic a Massage


Draping the weighted blanket over the user’s body distributes pressure evenly throughout their body. This has similar effects of a deep tissue massage. The pressure of the blanket goes deep within your tissues while you use it to fall asleep. A massage is supposed to help our body and mind relax – which can be easily done at home by using a weighted blanket. The physical factor of a massage might provide it’s own intimate yet soothing aspect, but the weighted blanket is proven to give you similar results to an actual massage in the long run.



10. Weighted Blankets Improve Cognitive Function


Taking a look at the overall therapeutic benefits of weighted blankets, we can see that it relieves stress, reduces tension, induces sleep, calms your mind and relaxes your body. These components are very important if you want to live a healthy and happy life.


Raised blood pressure, anxiety and lack of sleep are truly killers of productivity and normal behavior. Sleeping with the weighted blanket promotes the users overall well-being by ensuring that they tackle their daily issues with a clear head and a well-rested body.


With a clear mind, a person’s cognitive functions are improved. They are able to perform efficiently and effectively without being burdened by psychological issues and behavioral changes.




Weighted blankets can potentially solve sleep issues, panic attacks, anxiety related disorders, lack of concentration and even aggressive behavioral problems that affect the smooth proceedings of one’s daily life.

Successful results of the weighted blanket  can be had without the high costs of therapy sessions, drugs and sedatives that are traditionally used to pacify more tremulous patients. I recommend giving this effective and inexpensive blanket a try.







How to Use a Weighted Blanket


The blanket can be used at night, during naps, or used casually quick calming effect. Studies have used it for as little as 10 minutes and up to 2 hours, but it can stay on as long as you would like. It is the most beneficial to have your whole body covered, but do do not place the blanket on top of the head or face as it can create a suffocating sensation.



Choosing Your Weighted Blanket’s Weight


Use the formula 10% of your weight plus one pound. For example, a 160 lb person should  choose a 16 or 18 lb weighted blanket.



Thanks for visiting and reading …

I hope this article provided you some practical information on weighted blankets.

I welcome your comments below.




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Planning Ahead for Parkinson’s Needs

Planning Ahead for Parkinson’s Needs



Caring for a loved one with Parkinson’s disease at home can be like sailing a ship through uncharted waters. Currents, wind shifts and changing weather patterns all influence the ship’s course on a daily basis.

The effects of Parkinson’s disease also present an unpredictable course and caregivers must continually seek solutions and a positive direction for the care they provide.


Barbara’s Advice


Barbara has been caring for her husband for over 10 years.

He was diagnosed with Parkinson’s disease and she has remained steadfast with his care at home.

Through the years, she has been creative in developing practical ideas that save time, require less energy and reduce stress.

Most importantly, employment of these concepts has enabled her to maintain the dignity and independence of her husband:




Start Planning in the Early Stages


In the early stages of her husband’s disease, Barbara made an appointment for occupational and physical therapy consultations along with a home environment assessment.

This decision helped her to begin planning for the physical care and necessary home modifications to support her husband’s needs.

She offers these additional ideas for caregivers to customize their caregiving procedures as needs arise:



Mobility Aids/Furniture:


Wheelchairs — consider two separate chairs; one to use for indoor mobility and at the kitchen table (can be locked in place), and one to use for outings to the mall or family gatherings.





Walker — the best investment has been a four-wheeled walker with balloon tires, hand brakes and a padded seat. It glides over the ground and uneven surfaces and was paid for by Medicare and a co-insurance policy.




Recliner — add a wooden base to the chair to raise the height six to 10 inches. This makes it easier for the care receiver to get in and out of the chair alone.



Electric or Power lift chairs are another option and may be partially paid for by Medicare.




Bathroom Safety:


Install grab bars in several wall locations and a safety handle on the edge of the bathtub. Be sure to drill the bars into a wall stud for maximum hold and safety.




Remove the toilet seat and place a commode frame with arm rests over the toilet or purchase an elevated toilet seat with raised arms.



For sanitary purposes, keep flushable wet wipes available for use after toileting. Wipes can also be used to clean bathroom fixtures.




Add a non-skid bath mat, a bath bench and a handheld shower head to allow the care receiver to assist with their own shower.




For grooming, use an electric razor and an electric toothbrush to encourage self-care.






Incontinence Products:


Use incontinent pads and adult briefs in layers as needed for full protection against wetting through.







Clothes or Furniture:


Washable sheet protectors and chair pads can be used to save on constant laundering. For full protection, layer several pads on the bed or chair.




Floor Safety:


Use a Swiffer-type dry and wet mop on the floors for easier cleaning.

Do not use throw rugs, but if the floor surface is slippery, use a short-napped rug with a rubber backing.







Personal Safety:

Purchase a whistle and place it around the care receiver’s neck. This can be used to call for help, especially if the caregiver has a hearing deficit.

Place another whistle near the bed or toilet if needed.





Personal Emergency Response Systems (PERS) like GreatCall can be rented monthly to summon help when the caregiver is out of the home.







Alarm systems can be installed at exit doors and on wheelchairs to prevent wandering or falling.

Alarm systems can be installed at exit doors and on wheelchairs to prevent wandering or falling.



Transfer or gait belts can be used to keep the care receiver secure in the chair when the caregiver has to leave the room.

It can also be used to assist in safely helping the care receiver out of bed or a chair.





Mealtime Options:

Canvas aprons can be purchased at craft stores. Cut the ties off and replace with elastic on the top to enable the care receiver to put it on without help. Vinyl or quilted bibs/aprons can also be purchased from medical supply companies. Place the bottom half of the apron underneath the plate for neater mealtimes.

Use cups or glasses with lids and straw holes to prevent spilling. A two-handled cup with a spouted lid can also be kept by the bedside.




If the care receiver has tremors, buy shallow soup bowls and edge guards for plates to keep the food contained.

Purchase utensils with weighted, built-up or angled handles to help hands remain steady.







Car Ideas:


Car seats made of leather are easier to access and to clean.

Consider purchasing a swivel seat cushion to ease car transfers.


Pivot Disc

Some older adults can stand up from a wheelchair, but can’t turn around to sit in the car. This disc saves you from injuring your back or shoulders while helping them turn around.

With this pivot disc, your senior stands on the disc and you can slowly turn them so their back faces the car seat and they can sit down.



Purchase a handicapped vehicle parking permit  through the driver’s license bureau and have it authorized by the physician. Use the permit at any handicapped parking zone or at any meter in the city.

Pack a car tote bag. Include a package of wet wipes, bibs, a change of clothing, incontinent pads, plastic garbage bags, and water.

Eat in the car and park near a scenic area to enjoy the meal and the view if dining in a restaurant becomes too difficult.







Bedroom Solutions:


Consider the need for an electric hospital bed with a trapeze for movement and increased independence. This can be rented monthly through Medicare and a co-insurance policy.

Try nylon or silk pajamas for ease in turning in bed.  Use a bed guardrail for safety and support.








Dressing for Success:


Velcro Hush Puppy shoes are easier for the care receiver to put on and take off. Turn a lace-up shoe into a slip-on shoe with elastic shoelaces.

Purchase pull on boots with zippers for winter.

Use a long-handled shoe horn with a spring hinge.

The care receiver will have warmer feet and avoid falling by wearing slipper socks with rubber treads over regular socks. Thin stockings vs. cushioned sole socks are better on carpeted surfaces.

Sport pants and elastic waistbands ease dressing woes for the caregiver and care receiver.





Visual Cues:


Magnifying sheets, magnifying glasses, large wall clocks, talking watches and natural spectrum lamps help those with impaired vision and encourage independence.

Enriching Activities:

Review photo albums and old greeting cards.

Read the comics.

Listen to music and books on tape.

Enjoy walks in the park when able.

Create a memory box filled with past treasures or items that encourage reminiscence.

Display things around the home that bring joy such as family photos, children’s art work, and holiday decorations. This display also helps with time or seasonal orientation.

Consider attending a Parkinson’s disease support group together.





Final Thoughts

As one can see, revising care procedures and modifying your home can promote successful caregiving. In addition, these ideas will uphold the dignity and independence of the care receiver. Learn from others who have walked in your shoes and set your sails for a new direction in providing care for a loved one with Parkinson’s disease.


Based on an article by Kristine Dwyer and Barbara Churchill




Thanks for visiting and reading …

I hope this article provided you some helpful ideas.  I welcome your comments below.





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New Spoon for Hand Tremors

New Spoon for Hand Tremors Makes Mealtime Easier





Picking up a utensil to feed one’s self is a luxury that people take for granted. For others with neurological conditions causing tremors, this basic activity can be a source of frustration and embarrassment.


GYENNO’s ‘Smart Spoon’ tries to eliminate that problem. It’s a stabilization utensil gadget that offsets 85 percent of unwanted tremors for users affected by diseases like Parkinson’s.

The spoon has been in production for almost a year, and was revealed at the Consumer Electronics Showcase in Las Vegas in early January 2017.



While GYENNO’s product is still new to the North American consumer’s market, the technology has been employed in China for a while.


The utensil uses sophisticated stabilization control algorithms and motion learning technology to adjust to the user’s tremors, helping the person eat regularly.


This video is produced by the manufacturer, and demonstrates how the GYENNO Smart Spoon helps people with hand tremors eat independently:







The Smart Spoon is similar to another stabilization utensil from Lift Labs called Liftware, a Google purchase back in 2014.

GYENNO holds a patent for their own spoon’s tech, which they’ve called the best on the market.


“The GYENNO uses special PID [proportional–integral–derivative controller] control technology and attitude stabilization technology to make a better performance, higher frequency response and more accurate position control,” said Dehuai Li, marketing officer at GYENNO, in an interview with Motherboard.


“That makes [the GYENNO Spoon] 85 percent tremor canceling while Liftware just 75 percent.”



The GYENNO Package Contains:


1 Spoon Head

1  Fork Head

1  Intelligent

Hand Shank

1 Power Cable (the fully-charged battery can run for 180 minutes).






The GYENNO Spoon already has hundreds of users who have raved about being able to feed themselves once again, Li said.


  • Read Amazon consumer reviews of the GYENNO Spoon.


“You want to feed yourself, you don’t want someone else to feed you,” he said. “It improves your confidence and dignity. Many of these diseases have no cure, so we want to improve the quality of life.”


Through its cloud-based data collection, GYENNO has created its Medical Chronic Disease Management program to provide physicians and scientists with valuable information and statistics on the progression of symptoms and the disease in general.


For example, GYENNO Medical synchs the real-time symptoms of hand movements recorded by the GYENNO Spoon to study how the hand movements and tremors are expressed (frequency and amplitude, speed, accelerated speed and rotation of hand tremor). GYENNO collects data from users to assist scientists and physicians with research on disease progression, utilizing data-mining technology to explore data characteristics to help with early Parkinson’s Disease screening.



This video discusses everything that comes in the GYENNO Smart Spoon box, and provides a brief review:





Thoughts, questions, tips?  Feel free to comment below.


Thanks for visiting and reading … I hope this article provided you some helpful ideas.  I welcome your comments below.




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Get the Right Testing for Dementia




Many doctors use a common screening test called the Mini Mental Status Exam (MMSE) to check for possible cognitive issues.



The Mini Mental Status Exam is a first step, but it’s not good enough.


If you’re worried that your older adult is showing more than the forgetfulness of normal aging and that it might be signs of Alzheimer’s or dementia, the first step is to get a full physical and mental exam from their primary doctor.


How the Mini Mental Status Exam works

The MMSE is a common way of testing for dementia. It’s popular because it only takes 5 – 10 minutes and doesn’t require any equipment or special training for doctors or nurses.

The test has 30 questions, each worth 1 point. These questions test memory, orientation, and math skills.


The MMSE usually includes questions that measure:


  • Sense of date and time
  • Sense of location
  • Ability to remember a short list of common objects and later, repeat it back
  • Attention and ability to do basic math, like counting backward from 100 by increments of 7
  • Ability to name a couple of common objects
  • Complex cognitive function, like asking someone to draw a clock



The grading scale is:

25 or more points = no problem

21-24 points = mild cognitive impairment

10-20 points = moderate cognitive impairment

0-9 points = severe cognitive impairment


If someone gets a score in the 0 to 20 range, it can indicate cognitive issues. It doesn’t mean that they have dementia. It does mean that more extensive physical and cognitive testing should be done.

The MMSE can’t be used alone to diagnose dementia; it is a useful general screening tool, but can’t be used to diagnose dementia because there are many factors that could affect the test results.


Complicating factors include:


  • Physical injuries
  • Physical conditions like sleep apnea, which can cause memory or other cognitive problems
  • Conditions like depression
  • Trouble with math, especially for those with limited education
  • Trouble with language, especially for non-native English speakers, those who don’t speak any English, and people with limited education
  • Having a form of dementia that isn’t significantly affecting memory



Some dementia symptoms the MMSE would miss include:


  • Freely giving out bank account information to strangers
  • Suddenly spending money like crazy when they’re always been frugal
  • Making crazy investment decisions when they’ve always been conservative investors


A diagnosis can’t be made based on MMSE results alone

Non-geriatrics doctors often aren’t experienced in diagnosing Alzheimer’s or dementia. They might not know about the recommended testing and could jump to conclusions based on the MMSE results.

As a caregiver, it’s important to know that it’s simply not possible get an accurate diagnosis for your senior in just one office visit. A basic physical exam and MMSE screening doesn’t give enough information to declare a case of Alzheimer’s and prescribe medications like Namenda or Aricept.

Jumping to conclusions could cause your older adult to get the wrong treatment, which would clearly be bad for their health.


For example:


  • Your senior’s dementia-like symptoms could be caused by a treatable medical condition like heart disease, vitamin deficiency, or kidney failure.
  • Their symptoms could be caused by a medication side effect or drug interaction.
  • They could have signs of depression or another psychiatric issue.


Even if your older adult does have a form of dementia, how would the doctor know whether they have vascular dementia or Alzheimer’s or another type? Different types of dementia can require different treatment.

The MMSE is a useful tool because it’s quick, simple, and can be used by any doctor without special training. But it has significant limitations and cannot be used alone to make a diagnosis of Alzheimer’s or dementia.

In order to get an accurate and specific diagnosis, your older adult would need additional testing and evaluation to rule out other medical conditions, medication side effects, or psychiatric issues that could be causing dementia-like symptoms.


A More Sensitive Screening Test for Dementia

If you suspect your older adult could be showing signs of dementia and not just having some “senior moments,” the first step is to visit their primary doctor for a full check-up and the Mini Mental Status Exam (MMSE).  It possible cognitive issues are discovered, your loved one should go on to have the Montreal Cognitive Assessment (MoCA), which is a better, but not as commonly used screening test.


How the Montreal Cognitive Assessment (MoCA) Works

The Montreal Cognitive Assessment (MoCA) is a one page, 30 point test that takes about 10 minutes and doesn’t require the doctor to have any special training.


The MoCA usually tests these cognitive areas:


  • Ability to process and understand visual information about where objects are
  • Executive functions – ability to manage cognitive processes
  • Language
  • Short-term memory recall
  • Attention
  • Concentration
  • Working memory
  • Awareness of time and place



How are the MoCA and MMSE different?


The MoCA looks similar to the MMSE, but the MoCA tests a variety of different cognitive functions and the MMSE focuses mostly on memory and recall.

The MoCA is generally better at detecting mild impairment and early Alzheimer’s disease because it’s a more sensitive test and is more difficult. So, if a doctor sees a patient who is questioning their mental functioning, they might give the MoCA. But if a patient comes in and is clearly cognitively impaired, a very sensitive test wouldn’t be as necessary since the issues are more obvious.


The MoCA has also been shown to be a better screening tool for conditions like:


  • Parkinson’s disease
  • Vascular dementia
  • Traumatic brain injury (often from falls)
  • Huntington’s disease
  • Brain tumors
  • Multiple sclerosis



How are the MoCA and MMSE similar?


Even though these are good screening tools for cognitive impairments, neither test was designed to diagnose cognitive conditions.

They also can’t be used to distinguish between conditions. For example, you couldn’t use either test to diagnose someone with Alzheimer’s versus frontotemporal dementia. After the initial screening with one or both tests, referral to a specialist may be warranted and more testing would be needed.



Alzheimer’s Disease is Difficult to Diagnose


It’s best when a team of professionals — including a neurologist, neuropsychologist, geriatrician, and possibly others — works together to arrive at an accurate diagnosis.

A total diagnostic workup includes a medical history, imaging procedures, and neuropsychological testing, as well as other procedures depending on the individual’s presentation.

When a neuropsychologist or other professional in the field of psychology or psychiatry sees a person exhibiting symptoms of Alzheimer’s, a set of criteria is often used to help make an accurate diagnosis.


Criteria For an Alzheimer’s Diagnosis

The Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition), also known as the DSM-IV, outlines a detailed set of criteria for the diagnosis of Alzheimer’s.

First, multiple cognitive deficits must be present, one of which must be memory impairment.


In addition to problems with memory, one or more of the following must be displayed:


  • Apraxia — difficulty executing motor activities, even though movement, senses, and the ability to understand what is being asked are still intact
  • Agnosia — an impaired ability to recognize or identify objects, even though sensory abilities are intact
  • Problems with executive functioning, such as planning tasks, organizing projects, or carrying out goals in the proper sequence


In order to meet the criteria for Alzheimer’s disease, the deficits must affect one’s ability to hold a job or volunteer position, fulfill domestic responsibilities, and/or maintain social relationships.

The deficits must also represent a significant decline from the person’s previous level of functioning.

Alzheimer’s disease involves a gradual onset and progressive worsening of symptoms. In order to receive a diagnosis of Alzheimer’s, the deficits can’t be due to another medical condition, such as Parkinson’s disease, thyroid problems, or alcoholism. Similarly, the symptoms can’t occur exclusively during an episode of delirium, or be better explained by a psychological disorder such as depression or schizophrenia.


Recommended: Understand Alzheimer’s – A First-Time Caregiver’s Plan to Understand and Prepare for Alzheimer’s & Dementia

#1 Amazon Bestseller


A diagnosis of Alzheimer’s disease can be frightening and overwhelming-and not just for the patient. Becoming the primary caregiver for a newly diagnosed loved one can be one of the most challenging-and one of the most rewarding-experiences possible.

In Understand Alzheimer’s: A First-Time Caregiver’s Plan to Understand & Prepare for Alzheimer’s & Dementia, you’ll find a wealth of practical and useful information to help you and your loved one deal with a diagnosis of Alzheimer’s disease. Understand Alzheimer’s is a guide to providing compassionate care for a spouse, parent, sibling, or friend, from the early stages of Alzheimer’s disease until the end of life. 
Understand Alzheimer’s is a comprehensive and thoughtful guide to caring for a loved one with Alzheimer’s, with:


  • An in-depth explanation of the seven stages of Alzheimer’s disease and what the diagnosis means
  • Checklists for how to prepare your loved one’s surroundings for safety and ease of activities
  • Compassionate advice for managing your stress and finding the balance to keep you from feeling depressed, lonely, and isolated
  • A list of resources with information for supporting those with Alzheimer’s disease, and organizations that can help build a caregiving network
  • A guide to Alzheimer’s treatment options and a checklist for dealing with medical professionals
  • Helpful suggestions for managing the changes in your loved one’s behavior 

Living with Alzheimer’s disease presents daily challenges for both the caregiver and patient. Understand Alzheimer’s is a practical guide that helps you and your loved one cope with Alzheimer’s while maintaining the best quality of life possible for both of you.




An important note about urinary tract infections and dementia


When a senior starts acting confused or disoriented, it’s not always a sign of Alzheimer’s – especially if the change is sudden. Alzheimer’s and other dementias usually take several years to become noticeable and start with small changes.


Common medical conditions can cause seniors to suddenly show dementia-like symptoms or cause existing dementia symptoms to worsen significantly. One of the most common is a urinary tract infection (UTI).


Seniors are the most likely group of people to have a UTI. They’re also the group that’s least likely to have the usual symptoms like pain during urination, fever, or a frequent urge to go.

Instead, many caregivers find out their older adults have a UTI because there’s a sudden change in behavior. Someone who suddenly can’t do something they could a week ago might have a UTI. Falls, recent incontinence, or loss of appetite can also be signs of an infection.

If someone already has Alzheimer’s or dementia, they may also show sudden, unexplained behavior changes when they have a UTI.

Even though dementia is a progressive disease and symptoms do change over time, it’s a good idea to check for an infection when sudden changes happen. A UTI can make someone with dementia more agitated, difficult, confused, or less responsive than usual.

The UTI infection puts a lot of stress on your older adult’s immune system, which causes the changes in behavior, sometimes called delirium. Symptoms can include agitation, restlessness, difficulty concentrating, hallucinations, delusions, becoming unusually sleepy, or withdrawn.


UTIs can be detected with a simple urine sample. To save a trip, you should always have some home test kits on hand.  These kits give accurate results, and can arm you with information before you see the doctor.  This will save valuable time and allow treatment to begin sooner.


AZO Urinary Tract Infection Test Strips, 3-Count Box



Recommended: AZO Urinary Tract Infection Test Strips


If it’s a simple UTI and is caught early, taking antibiotics usually clears up the infection. Once the infection is gone, those scary behavior changes will start to disappear too.







If you think you or or loved one may be showing signs of Alzheimer’s Disease, you first step will be you family doctor, who will determine if further investigation is required.

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Caregiving for Parkinson’s Disease

Caregiving for Parkinson’s Disease Patients



Caring For a Loved One With PD Can Be a Challenging Job


Parkinson’s disease (PD) is a progressive, neurological disease that mainly affects movement but can also affect cognition. Parkinson’s disease results from the destruction of nerve cells in a part of the brain called the basal ganglia.

Different parts of the brain work together by sending signals to each other to coordinate all of our thoughts, movements, emotions, and senses. When we want to move, a signal is sent from the basal ganglia to the thalamus and then to the cerebral cortex, all different parts of the brain. Nerve cells in the brain communicate by using chemicals. A chemical (neurotransmitter) called dopamine is produced in a group of cells called the substantia nigra and is essential for normal movement.

When the cells die, they can no longer produce and send dopamine so the signal to move doesn’t get communicated.

By the time a person starts to experience motor symptoms of Parkinson’s they’ve already lost approximately 50% of their dopamine producing cells.  People may experience non-motor symptoms from loss of other neurotransmitters up to ten years before motor symptoms are noticed.





Caring for a loved one with PD can be a challenging job, especially as the disease progresses. Former caregivers of a loved one with PD suggest doing the following: Get prepared, Take care of yourself, Get help (don’t try to do it all yourself), Work to maintain a good relationship with your loved one, and Encourage the person with PD for whom you care, to stay active. Each of these will be covered in more detail later in this article.

Preparing for caregiving starts with education. Reading this article is a good start. 

Early Parkinson’s disease (PD) usually requires more emotional support and less hands-on care. It is a good time for family members/caregivers to educate themselves about the disease.



Who Gets Parkinson’s Disease?


Parkinson’s disease, documented in 1817 by physician James Parkinson, is the second most common neurodegenerative disease after Alzheimer’s disease.

Estimates regarding the number of people in the United States with Parkinson’s range from 500,000 to 1,500,000 with 50,000 to 60,000 new cases reported annually.

There is no objective test for Parkinson’s disease so the misdiagnosis rate can be high, especially when a professional who doesn’t regularly work with the disease makes the diagnosis.

Since Parkinson’s is more common in people 60 years old and older, it is expected that the incidence of Parkinson’s will increase with the aging of the baby boomers. Although PD is more common in older persons, some people do begin to experience symptoms before they are 40 years old.

Researchers have identified families who experience an increased incidence of PD, with some showing a genetic relationship from known PD genes. However, genetic causes of Parkinson’s are rare, only in approximately 6–8% of all cases. Most people diagnosed with PD do not have family members with PD. Recent studies show there may be a genetic predisposition to developing PD, but environmental exposure to certain toxins (many years prior to symptoms) may be needed to develop the disease. One common expression is “genetics loads the gun, but environmental [exposure] pulls the trigger.” Epidemiological studies are actively exploring the relationship between Parkinson’s Disease and exposure to agents such as herbicides, pesticides, and other toxins.



Symptoms of Parkinson’s Disease


All persons with Parkinson’s do not develop the same symptoms and any symptoms that do develop may change over time as the disease progresses. People will experience both motor and non-motor symptoms.

Typically PD motor symptoms start on one side of the body, and over time may progress to both sides. Often, one side is more affected than the other.


The primary symptoms most commonly associated with Parkinson’s disease are:


  • Tremor: Not all persons with PD develop tremor, but this is a common symptom. The tremor is described as a “pill rolling” action of the hand/fingers, usually most pronounced at rest, and may lessen with action, or movement. Tremor often starts on one side of the body—usually with the hand—but may also involve the arms, feet, legs, and chin.


  • Rigidity or Stiffness: In addition to making movement difficult, stiffness can also cause muscle aches. This symptom often is initially attributed to arthritis or pain syndromes and persons often seek medical attention for “frozen shoulder” symptoms or “tennis elbow” and other orthopedic complaints.


  • Slow Movement (bradykinesia), Loss of Movement (akinesia): Symptoms present with a decreased arm swing on one side, or decreased ability to perform usual motor tasks at usual speeds. They can lose the ability to make normal facial expression appearing “mask-like” to the person they are talking with. Family and friends may comment that the person smiles less or appears disinterested when in fact they are unable to make the facial muscles move in ways to help express what they are feeling.


  • Balance and Walking Problems: Initially persons have difficulty walking at normal speeds or may find it difficult to fully lift a leg, causing the foot to “drag” behind the other foot. Or, they may take unusually small steps to move forward or use several tiny steps to turn around. Eventually postural problems result in a stooped torso with a noticeable shuffling gait. The resulting body imbalance can cause the person to stumble or experience near falls. The person may no longer instinctually reach their arm out to “break” their fall putting them at greater risk for injury. Most people do not develop postural problems until many years after they have been diagnosed. Some individuals also experience episodes of “freezing” where they cannot move for several seconds or minutes. This is most common when they are approaching a doorway or other contained or small space.



Although there are no specific tests for Parkinson’s disease, there are several ways of making a diagnosis. Usually a diagnosis is based on a neurological exam that covers evaluation of the symptoms and their severity.


If symptoms are serious enough, a trial test of anti-Parkinson’s drugs may be used. Brain scans may be made to rule out other diseases whose symptoms resemble Parkinson’s disease.


There are always two of the above primary symptoms present when a diagnosis of Parkinson’s disease is made.


According to the Hoehn and Yahr scale, a commonly used system for describing how the symptoms of Parkinson’s disease progress, Parkinson’s disease has the following stages:


  • Prodromal symptoms (those symptoms that may develop many years before diagnosis): Depression, anxiety, fatigue, disturbance of color vision, constipation, loss of smell acuity (hyposmia), problems with sleep, slowed thinking.
  • Stage I: Motor symptoms on one side of the body
  • Stage II: Symptoms spread to both sides of the body
  • Stage III: Balance starts to become impaired
  • Stage IV: More difficulty with gait, freezing or small, fast steps. More problems that affect the center or mid-line of the body such as difficulty swallowing, balance and increased non-motor problems.
  • Stage V: Unable to locomote independently, becoming dependent on a wheelchair or other mobility device.




Recent research has identified primary non-motor symptoms of Parkinson’s disease which might be experienced up to 10 years before the motor symptoms appear:


  • Loss of olfaction (smell)/decreased acuity
  • Constipation
  • Sleep disorders (trouble falling asleep, staying asleep, yelling out or acting out one’s dreams.)
  • Pain
  • Seborrhea (flakiness of skin around nose, forehead, chin)
  • Fatigue
  • Depression: Approximately 40% of people with PD develop depression, which can be treated with medication and/or counseling. It is important for people with PD and their caregivers to report signs of depression to the physician. Persons with PD may not acknowledge their depression, and resist taking medication to treat this symptom



People with Parkinson’s can develop some of the following symptoms as the disease progresses:


  • Swallowing difficulties (Usually a later symptom): At least 50% of people with Parkinson’s develop swallowing problems (dysphagia) that may cause the person to drool, to spill food or liquid from the mouth or to send food to the back of the throat before it is ready to be swallowed. People with Parkinson’s and their caregivers should take care to watch for signs of choking due to food stuck in the throat, or increased congestion after eating. Due to difficulty coughing and clearing the lungs, people with Parkinson’s also run an increased risk of developing pneumonia. Swallowing problems can be helped with speech therapy.


  • Speech problems (Usually a later symptom): An estimated 60% to 90% percent of people with Parkinson’s will develop some difficulty speaking. A person with PD may speak very softly and may be hard to understand (hypophonia). Speech impairment is referred to as dysarthria and is often characterized as weak, slow, or uncoordinated speaking that can affect volume and/or pitch. The voice may sound hoarse or come out in short bursts. Often, speech problems worsen over time. Speech problems can be helped with speech therapy.


  • Cognition Issues (Processing and Using Information): The majority of people diagnosed with PD will experience some degree of cognitive impairment which increases in severity over time. An individual may experience forgetfulness, distractibility, weakening executive functioning skills (problem solving, planning, multi-tasking), slower mental processing (recalling names, learning new information) and language and visual-spatial difficulties. All medications should be monitored since high doses of some drugs used for Parkinson’s can cause cognitive impairment such as hallucinations or confusion.


Active diagnosis and treatment of the motor functions caused by Parkinson’s disease occurs to a greater degree than does the diagnosis and treatment of life-impairing cognitive disease-related conditions.

Often the family caregiver may notice cognition changes even before the care recipient may see them in him/herself. If you notice cognitive changes it is valuable information to discuss with the care recipient and to share with their doctor.


Additional PD symptoms may include:

  • Restlessness/anxiety
  • Eyelid Closure (dystonia of the eyelids can occur when a medication dose wears off)
  • Difficulty writing (small handwriting)
  • Urinary urgency and frequency (A later symptom: multiple trips to the bathroom, accidents)
  • Excessive sweating
  • Sexual problems (late symptom)


Treatment/Symptom Management



Drug Therapy and Research


If the disease progresses beyond minor symptoms, drug treatment may be indicated. Drug therapy for Parkinson’s typically provides relief for 10–15 years or more.



The most commonly prescribed medication is L-dopa (levodopa) and this helps replenish some of the depleted dopamine in the brain. Sinemet, a combination of levodopa and carbidopa, is the drug most doctors use to treat Parkinson’s disease.


Recent clinical studies have suggested, in the younger person, the class of drugs called “dopamine agonists” (a compound that activates dopamine receptors in the absence of dopamine) should be used prior to levodopa-carpidopa (Sinemet), except in patients with cognitive problems or hallucinations. In those older than 75, dopamine agonists should be used cautiously because of an added risk of hallucinations.


Other drugs are also used and new drugs are continually being tested. It is common for multiple drugs to be prescribed because many of them work well together to control symptoms and reduce side effects.


Contrary to past beliefs, starting Sinemet in newly diagnosed people does not lead to early symptoms of dyskinesia (involuntary movements such as twitching or jerking). Current knowledge is that the disease progression causes dyskinesias not a “resistance” to the drug.


Quality of life studies show that early treatment with dopaminergic medications improves daily functioning, prevents falls and improves a person’s sense of well-being.


It is very important for people with PD and their family caregiver to work closely with their doctor(s) and to seek advice from a Movement Disorders Specialist, who can best manage the more complicated aspects of the disease.


Over time, physicians add combinations of drugs and more frequent dosing is required as the disease progresses. In the more advanced stages, the Parkinson’s drugs provide a shorter time period where each dose is effective in controlling the symptoms. This shortened benefit from each dose is called “wearing off,” and the motor symptoms (and sometimes the non-motor symptoms, such as anxiety) return before the scheduled next dose.


People with PD need to pay close attention to the times they take their medications and note the length of time the medication helps their symptoms and how long the medication effects last before wearing off. This information helps the physician better determine the amount of medication and the schedule for its use.


Side Effects


As with all medications, side effects can be a problem. For some, starting Sinemet may cause dizziness or nausea, and are most severe when the person first begins taking the drug and gradually disappear or lessen with time. Sometimes adding extra “carbidopa” with each tab of Sinemet helps control the nausea.





For other medications, side effects may appear after several years. For example, long-term levodop use may result in large uncontrollable movements (dyskinesias) or “off” periods where the person becomes frozen (can’t move) until the next dose of medication is taken or a sensory trick is used. (Counting out loud, like a march, “One, two, three.”)


Another side effect in the more advanced stages and from larger doses of dopaminergic medications are visual hallucinations, where people at first see things in the corner of their visual field. Sometimes these hallucinations can be frightening.


There is a well described side effect from dopamine agonists that everyone who starts this class of medication should know about. Agonists and higher doses of Sinemet may cause impulse control (behavioral) problems. These behaviors vary, but may include: Excessive spending, gambling, sex, pornography or hoarding behaviors. Often reducing or stopping this class of medications stops the behavior. These behaviors can be so embarrassing for the care recipient and their family that too often the topic is avoided when talking with the doctor. Odd as it may feel, keeping track of unusual impulse behavior to report to the Neurologist can provide critical medical management information.


Sometimes, in the most advanced stages, a choice has to be made between motor function and cognitive function. High doses of medications may be required to manage the motor symptoms but these same doses cause hallucinations or paranoia.


At this point, a team meeting with all the medical providers and the family is advised to discuss the need to adjust the medications causing the side effects, yet balance the need to help the patient’s motor symptoms. Sometimes adding an anti-psychotic medication (such as quetiapine/Seroquel) is helpful. A multidisciplinary team meeting adds value and can help the family weigh the pros and cons of the PD medications with the caregiver and patient’s quality of life.

Surgery and Deep Brain Stimulation


Deep brain stimulation (DBS) is a treatment for Parkinson’s disease that uses an implantable pacemaker-like device to deliver electrical pulses to parts of the brain involved in movement.

The DBS system consists of leads precisely inserted into a specific brain target, the neurostimulator (pacemaker) implanted in the chest, and extension wires that connect the leads to the neurostimulator. Though implantation of the system (DBS surgery) requires a neurosurgical procedure, the treatment itself consists of long-term electrical stimulation.

Advantages of DBS include its ability to reduce the high doses of medications (avoiding the systemic side effects of medication), its adjustability (stimulation settings are programmed non-invasively using a wireless programmer by the clinician or a patient programmer), and its reversibility (can turn it on or off.) DBS was approved by the Food and Drug Administration as a treatment for PD in 2002 and according to Medtronic (the manufacturer of the DBS system), more than 80,000 patients have undergone DBS surgery worldwide.

Typical candidates are those who have motor fluctuations or periods of “off” time with troublesome symptoms alternating with periods of “on” time with good symptom control and also with possible periods of excessive movement (dyskinesia).


Not all patients with Parkinson’s disease are good candidates for treatment with DBS. Approximately 10–20% of patients considered for possible treatment with DBS include those:


  • With idiopathic (arising from unknown cause) Parkinson’s disease and not an atypical variety of parkinsonism
  • Who still respond, even if briefly during the day, to levodopa-containing medication
  • Who are significantly troubled by motor symptoms of Parkinson’s disease (slowness, stiffness, shaking, or other movement problems), despite taking an optimized regimen of medications
  • Who do not have significant problems with memory or other cognitive functions
  • Who do not have significant or untreated mental health issues, like depression or anxiety
  • Who have considered the likely benefits and potential risks of DBS and find this assessment acceptable for their situation.
  • Have reasonable expectations for what DBS likely will and will not do for them


Individuals whose condition meets these criteria are advised to seek a comprehensive evaluation from an experienced DBS team. This may be accomplished by requesting a referral from the patient’s neurologist to a DBS center.


The best candidates who have the most robust response to DBS tend to be younger than 70 years of age, with few center of the body symptoms such as swallowing and balance problems.

Non-Medical Interventions for Parkinson’s disease


Many caregivers and individuals with Parkinson’s Disease are interested in complementary therapies to supplement medications and other traditional PD treatments.

Increasingly, studies are showing that recreational physical activities such as walking, swimming, dance, yoga and Tai Chi can play an important role for individuals living with Parkinson’s disease.

Although there is no evidence that non-medical activities can affect disease progression, physical activity may assist with management of the symptoms of the disease while helping to increase enjoyment of life by staying active, having fun and learning new skills.

Innovative programs are increasingly available. For example, one popular program started in New York and replicated in other states and countries offers dance classes for individuals with PD. A San Francisco Bay Area Parkinson Group partnered with the Mark Morris Dance Group, a highly regarded modern dance company, to develop dance classes for persons with Parkinson’s disease (PD), friends, and family. Professional dancers teach the classes in a large dance studio with live piano accompaniment

Consult your doctor and Parkinson’s care team regarding the type of movement you would like to pursue. They can recommend how hard you should be working (intensity) and the duration of the activity. A recommendation from your doctor to consult with a Physical, Occupational or Speech Therapist is often useful. These professionals can assist you in evaluating how to use non-medical interventions in a way that best suits your needs.


Related Diagnosis: Lewy Body Dementia (LBD)


[LBD is an umbrella term for Parkinson’s Disease Dementia (PDD) and Dementia with Lewy Bodies (DLB).]

Current research is helping to differentiate dementia related conditions in relationship to Parkinson’s disease.

Doctor’s use a 12-month arbitrary rule to aid in diagnosis. When dementia is present before or within 1 year of Parkinson’s motor symptoms developing, an individual is diagnosed with DLB.

Those who have an existing diagnosis of Parkinson’s for more than a year and later develop dementia are diagnosed with PDD.

In the simplest terms, Lewy bodies are abnormal clumps of proteins that develop in nerve cells. Cholinesterase inhibitors, medications originally developed for Alzheimer’s disease, are the standard treatment today for cognitive DLB and PDD symptoms.



Early diagnosis is important as DLB patients may respond differently than Alzheimer’s disease patients to certain drug, behavioral and dementia care treatments.

Studies show that 10% to 70% of those living with PD will develop some degree of dementia (loss of brain function). This loss affects memory, thinking, language, judgment, and behavior.

A few of the signs of dementia in PD include slowed thinking, a more passive (or apathetic) personality, memory problems, and trouble with decision-making.

One particularly troubling symptom for a caregiver is when a care recipient experiences vivid hallucinations or delusions—the seeing or hearing things that are not really present but seem very real to the individual.

Frightening or dangerous hallucinations may call for a medical intervention. Use of certain antipsychotic medication can have highly debilitating side effects due to a hypersensitivity to these drugs by many LBD patients. Highly cautious use and careful monitoring by your doctor is critical should the use of these drugs become necessary. It’s also important to note that people living with LBD may or may not experience worsened hallucinations and delusions from medication used for PD such as levodopa. An individual can also experience disease induced episodes of paranoia and have sleep/wake cycle disruption.

This challenging, multi-system disorder involving movement, cognition, behavior, sleep and autonomic function requires a comprehensive treatment approach to maximize the quality of life for both the care recipient and their caregiver. It is very important to pay attention to symptoms of dementia and to search for an expert clinician who can diagnose the condition accurately.

Depression, which is common in both PD and LBD, can display the same symptoms as Alzheimer’s disease. Therefore it is important to work closely with a physician to rule out other possible causes for the changes in behavior and thinking.


Support for the Caregiver

Get Prepared


Many resources are available online and public libraries have literature on the disease. Whenever possible, accompany the person with Parkinson’s to their medical appointments and ask questions of the doctor, nurse and social worker.

The areas to assess include your loved one’s needs—both your perceptions and theirs, your home environment, and your own health, emotional state, and other commitments.

The caregiver has to determine how much they can and can’t do themselves and what type of outside support is needed. It is also important to assess current and future financial issues such as health insurance coverage, employment (both caregiver and the person with Parkinson’s), managing expenses, and if/when to get Power of Attorney.

Take Care of Yourself


Probably one of the most important, and sometimes difficult things caregivers can do is to take care of themselves. This includes maintaining mental and physical health by making and keeping your own medical and dental appointments.

As a caregiver, it is important to keep your job whenever possible as it provides not only financial help and possibly insurance coverage, but also a sense of self-esteem. Join a Support Group, for caregivers, if possible. Support groups help you meet people who are going through what you are going though, vent frustrations, give and receive mutual support, and exchange resource information and coping strategies.

Whenever possible get your sleep, take breaks, make and keep social activities, and try to keep your sense of humor.

Get Help


Get help—don’t try to do it all alone. By getting help a caregiver can lessen their sense of isolation, and it gives you more confidence in your own caregiving ability.

Having help increases your ability to think creatively and helps you get those needed breaks. Help is available through local and community services. These include neighbors, friends, churches, synagogues, senior centers, adult day health, Meals on Wheels, and door-to-door vans.

For a fee there is in-home care for help with cooking, bathing, dressing, and meal preparation. Additionally, a Social Worker from your health plan or hospital can connect you with other services.

Foster A Good Relationship


Lastly, maintaining your relationship and communication with the person with Parkinson’s can be the most challenging and rewarding aspect of caregiving.

As Parkinson’s disease progresses, the roles change and the person with Parkinson’s may go from being an independent head of the household to a very dependent person requiring a significant level of care. However, research shows that despite high levels of strain, caregivers with good quality relationships have reduced depression and better physical health. Remember, as a caregiver your service to your loved one is beyond measure in terms of love, depth of care, and concern.

For more information, visit the American Parkinson Disease Association and Parkinson’s Canada



Recommended Reading:

Michael S. Okun, M.D. is internationally celebrated as both a neurologist and a leading researcher. He has often been referred to as, “the voice of the Parkinson’s disease patient.” He was honored at the White House in 2015 as a Champion of Change for Parkinson’s disease. He has an international following on the National Parkinson Foundation’s Ask the Doctor web-forum and he is a Professor of Neurology at the University of Florida Health Center for Movement Disorders and Neurorestoration.
His many books and internet blog posts are brimming with up-to date and extremely practical information.
This book is the sequel to his runaway bestseller, Parkinson’s Treatment: 10 Secrets to a Happier Life, which was translated into over 20 languages.
Dr. Okun is well known for infusing his readers with positivity and optimism.In his latest book he reveals the breakthroughs in Parkinson’s disease that will pave the road to meaningful progress. In this book he reviews all of the recent breakthrough ideas and therapies in Parkinson’s disease, and he reviews the knowledge gained which is extending far beyond a single drug or stem cell.
He paints the broader and more exciting picture and reviews the portfolio of breakthroughs spanning drug, cell, vaccine, device, genetics, care, and behavior. He believes that patients and families with personal investments in Parkinson’s disease should be informed and updated about all of these potential breakthrough therapies. This book informs, educates, and will inspire Parkinson’s disease patients, family members, as well as health care professionals and scientists. As Dr. Okun points out, we will journey toward better treatments — and one day a cure. Read the reviews




Everything You Need to Know about Parkinson’s – All in One Place!

Written in plain, easy-to-understand language, this book teaches you everything you need to know to about Parkinson’s Disease, without you guessing or searching endlessly for answers to your biggest questions. This book is the result of 25 years experience and research in living a life with Parkinson’s Disease. It’s chock-full of vital facts, helpful hints and critical information… all in one easy to read book.


Here’s some of what you’re going to discover in the book:


  • Discover exactly what is Parkinson’s Disease. What causes it? How fast does it progress?
  • How to get correctly diagnosed in determining whether it’s really Parkinson’s disease.
  • Is Parkinson’s hereditary? Discover what the latest research shows about whether you should be concerned if your parent or close family ancestry had Parkinson’s.
  • 22 of the most common symptoms of Parkinson’s Disease. Learn these symptoms so you won’t be fooled by other ‘look alikes’.
  • What the latest research shows about the most effective ways to slow the progression of Parkinson’s.
  • The 5 Stages of Parkinson’s and how to identify which stage you’re at now.
  • How Parkinson’s can affect your life expectancy and whether people die from the disease. It’s a lot less scary than you think!
  • Why attending a Parkinson’s support group meeting may NOT be the best move for someone who has just been diagnosed with the disease.



This book isn’t just for the newly diagnosed:


  • What you should know about Essential Tremor and how it’s different from Parkinson’s Disease.
  • The role that age plays in getting Parkinson’s and what you should know about Early Onset Parkinson’s.
  • Why anxiety and depression are common in Parkinson’s patients and how to best alleviate these negative emotions.
  • The relationship between Parkinson’s and Alzheimer’s Disease.
  • The real cause of depression in Parkinson’s patients whether it’s caused by the disease or the side effects of the common medications.
  • What you should know about stress and how this can negatively impact you. Learn 5 simple techniques you can use to alleviate stress and reduce these effects.
  • What you should know about the common medications prescribed for Parkinson’s patients and the common side effects and long-term effects of the drugs.
  • Drugs you should avoid while on Parkinson’s medication and those you should definitely tell your pharmacist about if you’re using them.
  • 12 Ways to reduce nausea, a common side effect of many Parkinson’s Disease drugs.



You’ll find these tips too:


  • 8 Techniques you can use in order to prevent “freezing”. You’ll learn a neat little trick discovered by accident that works very effectively.
  • Learn how to know if you are getting the most out of your medicine. (How much “off” time is reasonable?)
  • Common things you should avoid to help reduce your tremors.
  • 11 Speech Therapy techniques you can use to improve your speech clarity.
  • 18 Tips for making chewing and swallowing of food much easier (these will come in very handy!)
  • 15 Tips for helping you to get a better night’s sleep.
  • 7 Main alternative treatments for Parkinson’s Disease you should know exist.
  • What you should know about the foods you should eat more of and those you should avoid like the plague.
  • What you should know about getting financial help from your government and other agencies
  • Helpful gadgets for people with Parkinson’s
  • And much more…



Thanks for visiting and reading …

I hope this article provided you some helpful ideas.  I welcome your comments below.






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Parkinson’s Disease Swallowing and Dental Problems

Parkinson’s Disease and Low Blood Pressure

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Parkinson’s Disease Myths

Parkinson’s Disease Myths


Image result for Parkinson's Disease Facts


If you or someone close to you has recently been diagnosed with Parkinson’s disease (PD), you are likely experiencing many emotions and have many concerns and questions.


Remember that you are not alone. As many as one million people in the US and an estimated seven to 10 million worldwide live with Parkinson’s disease. These estimates do not account for cases of PD that are unreported, undiagnosed or misdiagnosed.

With a diagnosis now in hand and the freedom to learn at your own pace, you can begin to understand PD and its treatments and the role they will play in your life. Your diagnosis can be the first step to taking charge of your life with Parkinson’s disease. 

There are many pervasive myths and misconceptions about Parkinson’s disease (PD) and its treatment.

Below are some tips to help you distinguish between fact and fiction so that you can optimize both your care and quality of life.






PD only affects movement. Most people – including some physicians – believe that PD only causes movement-related (motor) symptoms such as tremor, stiffness and slowness.



Many symptoms of PD are unrelated to movement. Nonmotor (“invisible symptoms”) of PD are common, and may affect everyday life more than the more obvious movement difficulties. These symptoms may include impaired sense of smell, sleep disorders, cognitive symptoms, constipation, bladder symptoms, sweating, sexual dysfunction, fatigue, pain (particularly in a limb), tingling, lightheadedness, anxiety and depression.



Good news: many nonmotor symptoms of PD are highly treatable. For this reason, you should write down your invisible symptoms, discuss them with your doctors, and seek treatment.





If someone with Parkinson’s looks good, then they also feel good. People will often assume that if someone with PD looks good at one point in time, then they will feel well all of the time.



PD symptoms fluctuate, and not all of them are visible. Over time, people with PD notice an increasing tendency for their medications to wear off between doses. For this reason, the way that they appear at one moment may not reflect the way that they feel most of the time. Even when someone with Parkinson’s looks good, they may not feel well because of nonmotor symptoms.



Keeping a symptom diary can help. If your symptoms fluctuate during the day, then you should keep track of your pattern of “on” times (when your medications work effectively) and “off” times (when medications wear off). This will enable your doctor to optimize your medications, and help you feel more in control of your PD.





You can blame PD for everything. It is easy for you – and for your doctors – to blame PD every time that you are not feeling well.



Certain symptoms should never be attributed to PD. Fever, for example, is not a symptom of PD, and usually indicates an infection. Headache, vision loss, vertigo, loss of sensation, loss of muscle strength and chest pain are not symptoms of PD.



Your doctors should rule out other causes for your symptoms. Sudden-onset symptoms – such as chest pain, shortness of breath, weakness, difficulty with speech, or vertigo – warrant immediate medical attention to rule out an emergency.





PD has spontaneous “exacerbations.” Another common assumption is that PD can “flare up” unexpectedly. But PD does not work this way. Although symptoms may fluctuate throughout the day, the progression of PD is very slow.



If PD symptoms worsen over days or weeks, then it is critical to search for an underlying cause. Medication changes, infection, dehydration, sleep deprivation, recent surgery, stress, or other medical problems can worsen PD symptoms. Urinary tract infections (even without bladder symptoms) are a particularly common cause.



Certain medications can worsen PD symptoms. These include antipsychotics, valproic acid (Depakote®) lithium, and nausea medications such as prochlorperazine (Compazine®), metoclopramide (Reglan®) and promethazine (Phenergan®). Speak with your neurologist before starting one of these medications, to see if there is a better alternative.






Levodopa stops working after five years. This is perhaps the single most pervasive myth about PD treatment. Many people are reluctant to start taking levodopa because of fear of “using it up.” Some physicians also share this “levodopa phobia.”



Levodopa works for decades. Levodopa does not treat all of the symptoms of PD, but it dramatically helps many of the most disabling motor symptoms.



Levodopa has been shown to increase lifespan and markedly improve quality of life.






You should wait as long as possible to take the next dose of levodopa. Many people feel that they should wait until their medication has completely worn off before taking the next dose.



Levodopa is most effective when taken on time, just before the previous dose wears off. If you wait too long, then the next dose may never “kick in,” and the medications may not work effectively for the rest of the day.



A medication timer can help. If you are experiencing wearing off of medications, then it is critical to take your doses exactly on time.





Different generic brands of carbidopa/levodopa are usually different colors.



The color of carbidopa/levodopa tablets is relatively consistent between brands. If the color of your tablets changes for no apparent reason, then it is important to verify that you are still receiving the correct dosage.



The most commonly described dosage of carbidopa/levodopa – 25/100 mg immediate-release tablets – is always yellow in color, regardless of the brand. If you are supposed to take this dose, and your pills are not yellow, than an error has occurred.





Your doctor can predict your future. Many people with PD ask their doctor to predict their prognosis.



PD is highly variable from person to person. Even a PD expert has no way of knowing what the future holds for an individual with PD.



You can help to change your future. You can improve your disease at every stage by ensuring that you stay fit and receive adequate sleep and proper nutrition. Exercise is particularly important for improving mobility, stamina, mood and quality of life.




Recommended Reading:

Here is a marvelous guide for anyone affected by Parkinson’s disease–patients, caregivers, family members, and friends.

Containing the most up-to-date information on the disease, one of the most common neurological disorders, it discusses the available treatments and provides practical advice on how to manage the disease in the long term.

Emphasizing life-style adjustments that will provide a better quality of life and moderate the burden for patients and their loved ones, the book answers many questions and clarifies misunderstandings regarding the disease.

Written by two experts on Parkinson’s disease and a freelance journalist, the book is approachable and easily understandable. Question and answer sections are provided, while “hot topics” are highlighted for easy visibility. The authors have also included true patient stories that will both inspire and instruct, and they have addressed several topics often not mentioned in physician-directed disease management, such as how to talk to family and friends about one’s life with Parkinson’s.

Over 100 Customer Reviews



Thanks for visiting and reading … I hope this article provided you some helpful ideas.  I welcome your comments below.






You may also be interested in:

Planning Ahead for Parkinson’s Needs

Best Exercises for Parkinson’s Disease – A Complete Physical Activity Guide

New Spoon for Hand Tremors Helps at Mealtime

Caregiving for Parkinson’s Disease

Parkinson’s Swallowing and Dental Problems

Parkinson’s Disease and Low Blood Pressure

Getting the Right Testing for Dementia

About Me

Create Your Own Blog


Parkinson’s Swallowing and Dental Problems

Parkinson’s Swallowing and Dental Problems




Most people with PD (Parkinson’s Disease)  have swallowing problems.

This article outlines the effects of PD on swallowing and dental health and provide tips for staying safe, eating well and establishing a routine for dental care.


Parkinson’s and Swallowing


Because swallowing involves a very complex sequence of movements, it is no surprise that PD — a movement disorder — affects swallowing.

For example, the slowness of movement that often comes with PD may affect chewing, biting, the ability to work the tongue and the ability to get food or liquid down in one bite.


What are other signs of a problem? A person with PD may lose food or liquid out of the mouth, may swallow in small bites or sips or may have difficulty with certain textures. He or she may stop eating foods that are difficult to swallow, may cough or have a wet or hoarse voice while eating and drinking.

The term for swallowing difficulty is dysphagia. It affects the mechanics of swallowing and quality of life. Many people become frustrated or embarrassed and isolate themselves from social activities such as dining with friends or family.

More importantly, dysphagia can lead to malnutrition, dehydration and aspiration (when food or liquid “goes down the wrong pipe”). Aspiration, which can sometimes be “silent,” meaning a person does not cough or choke, can lead to aspiration pneumonia — the leading cause of death in PD. Thus, it is important to ensure that people with PD can swallow effectively and eat safely.


What Can Be Done?

The first step to addressing swallowing issues is to speak to a neurologist about getting an evaluation performed by a speech-language pathologist (SLP). This professional will take a medical history and interview the person with PD about eating and swallowing.

This is typically followed by either a video x-ray or an endoscopic examination, which allow the medical specialist to observe the swallowing process as an individual sips liquid and eats food, as these substances flow from the mouth, down the throat and esophagus, to the stomach.

With these tests, it is possible to see where exactly the trouble is occurring, and to recommend therapies.

Follow the recommendations of the swallowing specialist, which may include the following:


Exercise and Swallow Hard. Just as exercise can ease other PD-related movement difficulties, it can also help with swallowing.

One technique is the Lee Silverman Voice Technique® (LSVT®), familiar to many people with PD as a therapy to help people improve speech. It helps a person to exaggerate speaking and swallowing.

In addition, working with an SLP on an individualized program can help the person to swallow hard and move food from the mouth down the throat.


Expiratory Muscle Strength Training. This therapy strengthens respiratory muscles, improves cough and swallowing and reduces aspiration.


Change the Food. Modifying liquids into solids can help. For people who find that liquids get into the airway, liquids need to be thickened or avoided completely.



Tip:  For those who are having difficulty eating enough nutrition and calories, I recommend using a thickener in a nutritional supplement drink to make a meal replacement “pudding.”

When my mother barely eating, we gave her Boost Very High Calorie Nutritional Drinks.  They are very palatable, and don’t contain lactose.  This is a good option to provide much-needed calories, and can be thickened into a pudding with Thick-It.  (You can read about what happened to my mother here).

Swallowing difficulties can also be eased by taking bigger or smaller bites or sips — or by pureeing the solid foods. The best first step is to obtain an evaluation, so the SLP can recommend how to modify food and liquid.





Parkinson’s and Dental Care


Regular visits to the dentist are important for all of us. For a person who has PD, dental care is even more critical because PD can impact the health of the mouth, teeth and jaw and make dental care challenging.

Rigidity or tremor may make it difficult to brush one’s teeth. Symptoms such as fatigue, anxiety and tremor can make it difficult to commute to appointments, sit still in the dentist’s chair or open the mouth wide.

Common PD symptoms and side effects such as rigidity, tremor and dyskinesias can cause discomfort in the joint that connects the lower jaw to the skull.

They can also be a cause of cracked teeth, tooth wear, changes in the fit and wear of dentures and tooth grinding.

Too much saliva can lead to a fungal infection at the corners of the mouth, which is easily treated.

By contrast, too little saliva or dry mouth increases the risk of cavities. Sucking on sugar-free hard candy or using artificial saliva substitutes can help. It may also help to avoid alcohol, tobacco and spicy and acidic foods.


Tips for Visits to the Dentist


A few tips can significantly improve dental visits. Call first to make the office aware of you or your loved one’s PD symptoms. This will help the dentist and the staff to provide better treatment.

The dentist should have a sense of overall health of a person with PD, and someone on staff should record vital signs upon arrival.

It is important to tell the dentist if the person with PD is taking MAO-B inhibitors (rasagiline and selegiline), as these may interact with anesthetics.

Lastly, because dental visits may become more troublesome as PD progresses, consider scheduling the replacement of old fillings, crowns and bridges, and ill-fitting dentures, during the early stages of PD.


Tips For the Dental Appointment


  • Ask to keep the dental chair more upright, to make swallowing easier.
  • Plan short appointments early in the day.
  • Schedule appointments to start about 60-90 minutes after a levodopa dose.
  • After the treatment is over, get up slowly from the dental chair (to prevent dizziness).
  • Request all instructions in writing, with copies for the care partner as well as the patient.
  • Schedule check-ups and cleanings every three to six months.
  • For people who wear dentures, the dentist should screen for oral cancer and evaluate the fit of the dentures as part of the routine visit.


Dental Tips for Home

Regular brushing, flossing and rinsing with an over-the-counter fluoride rinse help prevent cavities and gum disease, but PD movement symptoms can interfere with one’s ability to maintain oral hygiene.
People with PD should try using a toothbrush with a large-handled grip and soft bristles. A small brush head reaches the corners better. To make the toothbrush easier to grasp, it may help to place the handle inside a bike handlebar grip or tennis ball or to use an electric toothbrush.

Aim to brush after every meal for two minutes, and also brush the tongue. It’s best to brush one-handed, using the stronger side of the body. If it’s not possible to brush after a meal, simply rinsing the mouth with water will help.

Flossing is important, but may mean getting help from a care partner. For fluoride rinses, if swishing and spitting are difficult, the dentist may recommend a brush or sponge applicator. Antimicrobial mouth rinses also can be applied with a brush.

If you have dentures, remove after each meal, brush and rinse them. At night, brush or clean them in a solution.


The online community at The Michael J. Fox Foundation offer these suggestions for daily dental homecare:


  • Brush your teeth while listening to music. For some people with PD, music can help calm movement and may help you get into a rhythm making tooth brushing easier.
  • Invest in an electric toothbrush. While a bit pricier than manual toothbrushes, going electric can make brushing teeth much easier. Get an electric toothbrush with a 2-minute timer.




  • Talk with your dentist about prescription toothpaste, one with a higher percentage of fluoride than regular paste. PD medications can cause dry mouth, leading to cavities and gum disease.
  • A water flosser (e.g. WaterPik) helps clean between teeth and may be easier to use than string floss.




  • Use a small dab of toothpaste and encourage spitting so not to swallow excess paste.


  • Sit while you brush. Set up a mirror at chair level and use the chair arms to help steady you while brushing.


Find a balance between maintaining independence and asking for help when you need it. A dental hygienist can help you or your caregiver with good techniques


Some additional suggestions are:

  • Safely clean dentures daily by attaching a nailbrush to a household surface with a suction cup and then moving the denture back and forth across the brush.
  • Have regular dental examinations and cleanings. Schedule morning appointments when waiting time is shorter and plan for several shorter appointments.



Final Thoughts

Parkinson’s can affect a person’s ability to swallow, and maintain dental and oral health.The good news is you, or a loved one with PD, can address these difficulties, while making meals enjoyable.


Recommended Reading:



Thanks for visiting and reading …

I hope this article provided some helpful ideas.  I welcome your comments below.







You may also be interested in:

Planning Ahead for Parkinson’s Needs

New Spoon for Hand Tremors Helps at Mealtime

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Best Exercises for Parkinson’s Disease – A Complete Physical Activity Guide

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Parkinson’s Disease and Low Blood Pressure



Parkinson’s Disease and Low Blood Pressure






Parkinson’s patients commonly experience a condition known as orthostatic hypotension (OH), or low blood pressure. 


If you have experienced it, you may already know that this symptom is common in mid- and late-stage Parkinson’s disease (PD), and it can be quite alarming.

Orthostatic hypotension is a sharp drop in blood pressure that happens when a person gets up from bed or from a chair, causing dizziness or even loss of consciousness. 

Doctors define it as a blood pressure drop of 20 millimeters of mercury (20 mm Hg) in systolic blood pressure (the top number in a blood pressure reading), or a drop of 10 millimeters in diastolic blood pressure (the bottom number), within three minutes after standing up.

The condition can put people with Parkinson’s at risk of fainting, losing balance, falling, and being injured. 

What can you do?  One thing you can do is learn strategies to predict when blood pressure is most likely to fall.  Another is to take steps to avoid feeling dizzy in the first place.


Symptoms of Low Blood Pressure in Parkinson’s Patients


Your doctor can test for OH by measuring your blood pressure.  If you feel a little dizzy when you first stand up — but the feeling passes quickly — you probably do not have the condition. 

If instead your blood pressure continues to drop after a minute or more of standing, this may suggest a problem.

It is important that your physician measure your blood pressure while you are lying down, sitting and standing.  Sometimes, the problem of OH is only revealed when the blood pressure is measured in these three positions.
The symptoms of OH include the following:


  •     lightheadedness
  •     dizziness
  •     weakness
  •     difficulty thinking
  •     headache
  •     feeling faint




Causes of Low Blood Pressure in Parkinson’s Patients


Normally, when a person rises from lying down or sitting, the blood vessels constrict and send blood from the legs and trunk up to the head.  In addition, the heart beats slightly faster and more forcefully.  In people living with PD, the heart rate may not increase upon standing, and the blood pressure may drop as a result.

Both Parkinson’s itself, and the medications that are used to treat it, can contribute to OH.  In addition, people with Parkinson’s may be on other medications that affect blood pressure. 

Specifically, the medications that can cause OH in Parkinson’s include carbidopa/levodopa (Sinemet®), bromocriptine (Parlodel®), ropinirole (Requip®), and pramipexole (Mirapex®); drugs for high blood pressure, including calcium channel blockers; certain antidepressants;  drugs to treat urinary problems, such as prazosin (Minipress®) and terazosin (Hytrin®); and drugs for erectile dysfunction (e.g., Viagra®).

Additional causes include diuretics, cardiac disease, dehydration, fever, and anemia.




How to Avoid Orthostatic Hypotension in Parkinson’s Patients


If you can recognize your symptoms and are aware of what makes them worse, you can take steps to reduce and avoid them.

Most important is to avoid dehydration, especially during the months of hot weather. 

Ask your doctor to identify the medications you are taking that may lower your blood pressure, and see if a change in dose is indicated. 

Avoid abrupt changes in position.


Be aware of behaviors and circumstances that can make orthostatic hypotension worse, such as:


  • dehydration
  • exposure to heat
  • fever
  • prolonged standing
  • vigorous exercise
  • drinking alcohol
  • certain times of day (especially early morning)
  • straining while going to the bathroom
  • changing the position of the body (e.g., standing up)
  • meals high in carbohydrates





Drug Therapies for Low Blood Pressure in Parkinson’s Patients


Ask your doctor whether there are any medicinal approaches that will help you manage OH and its effects.   Options may include droxidopa (NORTHERA™),midodrine hydrochloride (ProAmatine®), fludrocortisone (Florinef®) or pyridostigmine (Mestinon®).  Be aware that medications that raise low blood pressure to normal levels when a person is standing may cause high blood pressure when a person is lying down.

Tips for Avoiding Orthostatic Hypotension in Parkinson’s Patients


  • Drink lots of water and other fluids, at least one cup (eight ounces) with meals and two more at other times of the day.
  • After consulting your doctor, increase your salt intake by eating prepared soups or pretzels.  (Note: for people with heart disease, this should be avoided.)
  • Exercise gently and regularly — and avoid long periods of inactivity.
  • Eat small, frequent meals.
  • Reduce alcohol intake.
  • Avoid hot drinks and hot foods.
  • If you expect to be standing for a long period of time — while shopping, for example — quickly drink two eight-ounce glasses of cold water.  This will increase blood volume and causes blood pressure to go up for a couple of hours.


If you experience dizziness in the morning:


  • Raise the head of the bed by four inches (10 cm).
  • Drink two eight-ounce cups of cold water 30 minutes before getting up.
  • Do isometric exercises before getting up that contract the leg or feet muscles.  For example, raise the toes, contract the thigh muscles and hold for 30 seconds, or march the legs slowly in place.
  • Shift slowly from lying to sitting and then standing.
  • Try putting on an abdominal binder before you get out of bed (and remove it before lying down again).  Compression garments such as antigravity stockings can be effective in preventing OH.



Recommended Reading:

Recent innovations, including deep brain stimulation and new medications, have significantly improved the lives of people who have Parkinson’s disease.

Nevertheless, patients and families continue to face many challenges.

They have long relied on this book for reliable advice about medical, emotional, and physical issues. Bringing this trusted guide up to date, three expert neurologists describe:

• New understandings gained by five years of additional research on Parkinson’s disease

• New focus on the importance of exercise

• New information about imaging techniques such as SPECT Scan and DATScan that are aiding in the diagnosis

• New findings about the genetics of the disease

• Promising uses of new technologies such as tablet devices for people who have trouble communicating

• Information about impulse control disorders caused by some drugs used to address the symptoms of the disease

• A complete update on treatments such as medications, surgery, and more



Recommended BP Monitor:

Omron 10 Series Wireless Upper Arm Blood Pressure Monitor with Widerange ComFit(TM) Cuff


No. 1 doctor and pharmacist recommended home blood pressure monitor

Manage and track up to 200 readings on your blood pressure monitor and unlimited readings on your smartphone with Omron’s free iOS and Android applications

Comfortable and simple to adjust, the pre-formed ComFit(TM) Cuff inflates around the entire arm to avoid incorrect cuff positioning ensuring a precise reading and expandable cuff fits standard and large arms

Easy-to-read screen features a backlight, extra large digits and multi-colored indicator lights that show how your reading compares to normal home blood pressure levels

Feel empowered by accuracy with exclusive technology that automatically displays the average of your last 3 readings taken within the last 10 minutes and detects irregular heartbeats.




Thanks for visiting and reading …

I hope this article provided you some helpful ideas.  I welcome your comments below.








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Planning Ahead for Parkinson’s Needs

Best Exercises for Parkinson’s Disease – A Complete Physical Activity Guide

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Caregiving for Parkinson’s Disease

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Best Blood Pressure Monitors Under $50

Preparing For Your Elderly Parent to Move In

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