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As Parkinson's disease progresses, a multidisciplinary team approach is usually the best approach for maintaining the quality of life of the patient. The team members may include a doctor (e.g., Parkinson's disease specialist, neurosurgeon, urologist), nurse, social worker, physical therapist, occupational therapist, speech therapist, nutritionist and, perhaps, even complementary medicine professionals, among others.

Lifestyle interventions for Parkinson's disease associated symptoms include:

Problems with Walking

Exercise and physical activity are important in maintaining muscle strength, function and coordination. Physical therapists can teach new methods for standing, turning, and walking that can maximize function and reduce the risk of falling. There are a variety of techniques for managing the freezing phenomenon that can significantly improve mobility and safety.

Problems with Drooling

To reduce nighttime drooling, the patient may be helped by sleeping in a more upright position. The patient will also be taught to swallow more frequently than before, especially while eating. In addition, speech therapists can teach the Parkinson's disease patient how to strengthen the muscles used in swallowing.

When the drooling becomes pronounced, some doctors prescribe levodopa or dopamine agonists, though their benefit is limited. Anticholinergic drugs may be beneficial but they have several side effects including constipation, urine retention, and cognitive impairments, especially in the older patients.

A drug that is now being evaluated to reduce drooling is botulinum toxin which is injected into each parotid gland (the gland that produces saliva in the base of the mouth). Preliminary studies indicate that drooling is decreased for several weeks.

Speech Problems

A speech therapist is very helpful in evaluating and implementing techniques and suggestions for optimizing voice and speech function. Issues such as hurried speech and soft voice can all be addressed. The therapist can also coach the patient and suggest methods to improve communication.

Some patients undergo an experimental procedure where collagen is injected into the vocal folds of the larynx to enhance vocal quality.

Depression

There are several avenues to helping the Parkinson's disease patient diagnosed with depression. Among these are:

• Counseling - individual or group counseling
• Consultation with a social worker or psychologist/psychiatrist who may be able to help identify sources of stress and anxiety and help make changes and readjustments in every day life to reduce them
• Exercise (e.g., walking) or other physical activity which not only impacts depression but has the added benefit of alleviating motor complications in some patients
• Medications - The most commonly used antidepressants are selective serotonin reuptake inhibitors (SSRIs) and tricyclic antidepressants (TCAs). Some doctors prefer SSRIs because they are tolerated easily and do not affect mood or memory. TCAs cause significant orthostatic hypotension (drop in blood pressure when in standing position) in some patients and have more side effects (e.g., dry mouth, blurred vision, and cognitive impairment). They also can be dangerous for patients with certain cardiac conditions.

Some studies suggest that the dopamine agonist pramipexole is also effective for treating depression in Parkinson's disease and some doctors prefer to try this drug before suggesting antidepressants.

Sleep Disturbances