How can a 67-year-old man manage his Parkinson’s symptoms?

Question

Hi doctor,

A 67-year-old man with a five-year history of Parkinson’s disease presents with increasing difficulty walking and more frequent tremors in both hands over the past two months. He reports stiffness in his legs, slower movements, and episodes where his feet seem “stuck to the floor,” especially when turning or walking through narrow spaces. His wife notes that his handwriting has become smaller and shakier. He also complains of disturbed sleep, vivid dreams, and occasional early-morning stiffness.

On examination, he has a resting tremor, rigidity in all four limbs, and a shuffling gait. His recent UPDRS score has increased from 32 to 48, indicating worsening motor symptoms. He is currently taking Levodopa–Carbidopa but notices that its effect wears off sooner, leaving him with several “off” periods throughout the day. He also has mild constipation and a reduced sense of smell, both of which have interfered with his daily routine.

He wants to know whether his medication needs adjustment, whether adding therapies such as COMT inhibitors or dopamine agonists may help, and what exercises could improve his mobility. He is also concerned about future progression and seeks guidance on maintaining independence and preventing falls.

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

Your symptoms suggest that your Parkinson’s disease has progressed slightly, and your current levodopa dose is not lasting as long as before. This is why you are experiencing more tremors, stiffness, and “freezing” episodes where your feet feel stuck. These “off” periods are very common after a few years on Levodopa.

Your UPDRS (Unified Parkinson’s disease rating scale) increased from 32 to 48, which also confirms that your motor control has worsened. This does not indicate a sudden decline, but it does mean that your treatment needs to be fine-tuned to match the stage of the disease you are in now.

We can certainly adjust your medications. The first step is often to increase the frequency of Levodopa–Carbidopa (smaller doses given more often). This helps reduce the wearing off you have been noticing.

Adding another medicine can also help smooth out these fluctuations. Drugs such as COMT (catechol-O-methyltransferase) inhibitors (Entacapone, Opicapone) or MAO-B (monoamine oxidase-B) inhibitors (Rasagiline, Selegiline) help each dose of Levodopa last longer. Dopamine agonists such as Pramipexole, Ropinirole, and Rotigotine patches can also reduce tremor and help during “off” periods, but they are chosen carefully if you experience sleepiness or vivid dreams.

Your freezing episodes and shuffling gait can improve with physiotherapy. Parkinson exercises are very effective, such as big-movement training, treadmill walking, cycling, and regular stretching of the legs and hips. Practising wide turns and stepping over visual cues (like a line on the floor) can reduce freezing.

Sleep disturbance and vivid dreams may be part of REM (rapid eye movement) sleep behaviour disorder, which is common in Parkinson’s. Adjusting the timing of evening medications and using melatonin can help you sleep more safely.

Constipation is also part of Parkinson’s, and not your fault. Increasing water intake, adding fibre, and using daily stool softeners can help regulate bowel movements.

For safety, fall-prevention strategies are important early on. Avoid cluttered pathways, ensure good lighting, use handrails, and take your time when turning. If freezing worsens, a physiotherapist can teach cueing techniques to lower your fall risk.

Regarding future progression, Parkinson’s typically progresses slowly, and most patients maintain independence for many years with the right combination of medication, exercise, and therapy. Your symptoms are manageable with appropriate treatment adjustments.

I hope this has helped you.

Please feel free to reach out to me again for further queries.

Thank you.