Motor

• Bradykinesia: slowness (buttoning, handwriting smaller)
• Rigidity: stiffness, reduced arm swing
• Rest tremor: often one-sided “pill-rolling”
• Postural instability: imbalance, freezing of gait

Non-motor

• Constipation, decreased smell, sleep changes (REM behavior disorder)
• Depression, anxiety, apathy
• Low blood pressure on standing (light-headedness)
• Mild cognitive changes; later, possible dementia

• Neurologic exam for bradykinesia plus tremor/rigidity
• Response to levodopa supports the diagnosis
• Imaging is usually not required; sometimes used to rule out other causes

Levodopa (+ carbidopa)

• Most effective for slowness, stiffness, tremor
• Best taken on schedule; protein can reduce absorption for some—ask about timing
• Later, wearing-off or dyskinesias may occur; dosing is adjusted

Other options

• MAO-B inhibitors: selegiline, rasagiline, safinamide
• Dopamine agonists: pramipexole, ropinirole, rotigotine patch
• COMT inhibitors: entacapone, opicapone (extend levodopa effect)
• Amantadine: may reduce dyskinesias

Therapies

• Physiotherapy: gait, posture, cueing for freezing
• Occupational therapy: safer daily tasks, home setup
• Speech therapy: voice volume (LSVT LOUD), swallowing

Exercise that helps

• Brisk walking or cycling; 150+ minutes/week as tolerated
• Strength & balance 2–3×/week (sit-to-stands, heel-to-toe)
• Big-amplitude moves (LSVT BIG-style), dance, tai chi, boxing programs

• Stand up slowly; pause before first step
• Use visual or auditory cues to overcome freezing (laser line, metronome, “1-2-3 step”)
• Sturdy shoes; remove loose rugs; add night lights and grab bars

• Speak up: deliberate loudness practice improves clarity
• Swallow tips: upright posture, small bites/sips, double swallow
• Moisten foods; review for silent aspiration if coughing at meals

• Fluids through the day; fiber from fruits, vegetables, oats
• Regular toilet timing after meals; gentle activity
• Osmotic laxatives or stool softeners if advised

Bladder tips

• Limit evening fluids; avoid caffeine late
• Pelvic floor exercises; ask about bladder medicines if urgency/frequency wake you at night

• Set a wind-down routine; light, quiet, and cool bedroom
• Address nocturia and leg cramps; keep pathways lit
• Talk to your clinician about REM behavior disorder and restless legs

• Depression/anxiety are common and treatable—therapy, activity, and medicines can help
• Mild thinking changes: use lists, one task at a time, routine

Hallucinations

• Report visual hallucinations; review medicines first
• Specialized treatments may be considered if distressing

Deep Brain Stimulation (DBS)

• Helps tremor, wearing-off, and dyskinesias in selected patients
• Requires evaluation of symptoms, response to levodopa, and thinking/mood status

Levodopa infusions / pumps

• Continuous delivery for advanced wearing-off
• Discuss benefits, device care, and eligibility with specialists

• Take medicines on time; set alarms; carry a daily list
• Move daily (walk, stretch, balance); schedule therapy tune-ups
• Hydration and fiber for bowels; review sleep and mood regularly

• Fall-proof the home; consider a cane/walker if advised
• Keep dental, vision, and hearing up to date
• Plan rides; avoid driving if sleepiness or reaction time concerns

Support daily routines

• Consistent medicine timing; simple calendars and pill boxes
• Encourage exercise classes and safe social time
• Track falls, sleep, bowel habits, and new symptoms for visits

Is tremor required for Parkinson’s?

No. Slowness and stiffness can be prominent without tremor, especially early.

When to start levodopa?

When symptoms affect function or quality of life. Early use doesn’t “make it wear out”; dosing is individualized.

Best exercise?

The one you’ll do consistently: brisk walking or cycling plus strength, stretching, and balance. Big-amplitude training helps.

What about diet?

Balanced meals; fiber and fluids for constipation. Some separate higher-protein meals from levodopa doses—ask your clinician.