How to manage Parkinson's disease in a 67-year-old woman?

Question

Hi doctor,

My 67-year-old mother was diagnosed with Parkinson's disease three years ago, and it is progressing faster than expected. She is on Carbidopa and Levodopa but is having wearing-off episodes every four to five hours. The neurologist added Pramipexole, but she has developed compulsive shopping behavior for things she does not need. What is concerning is that her tremors get much worse during her menstrual cycle. She has been through menopause for 15 years, but still has cyclical symptoms.

The movement disorder specialist said women with Parkinson's often have different symptoms from men. She is falling more frequently and broke her wrist last month. Her bone density scan showed osteoporosis, which the doctor says is common in women with Parkinson's. Are there different treatment approaches for women with this condition?

Please guide.

Thank you.

Answer 1

Hi,

Welcome to icliniq.com.

I read your query and understand your concerns.

Thank you for your detailed question.

Women with Parkinson’s disease (PD) often experience a different symptom profile than men, including more frequent dyskinesias, mood fluctuations, and medication sensitivity. The wearing-off episodes you are seeing every four to five hours with Carbidopa and Levodopa are common as the disease progresses.

Adding Pramipexole can help extend symptom control. But impulse control disorders (ICDs) like compulsive shopping are well-documented side effects of dopamine agonists (like Pramipexole), particularly in women.

In her case, it may be necessary to reduce or discontinue Pramipexole and consider alternative strategies like Levodopa dose fractionation, catechol-O-methyltransferase (COMT) inhibitors (Entacapone), or monoamine oxidase-B (MAO-B) inhibitors (Rasagiline) to better smooth out fluctuations without triggering behavioral side effects.

Her worsening symptoms that seem cyclical despite menopause could reflect underlying hormonal sensitivities or mood-driven fluctuations, which we sometimes see in postmenopausal women. These may be responsive to careful medication timing or supportive treatments. The increased falls and recent fractures are concerning and highlight how PD contributes to both postural instability and osteoporosis, which disproportionately affects women.

Coordinated care involving neurology, endocrinology (for bone health), and physical therapy (PT) is essential. Fall prevention, dual-energy X-ray absorptiometry (DEXA) scan monitoring, weight-bearing exercises, and possibly starting bisphosphonates or other osteoporosis treatment are all crucial.

I hope this helps.

Kindly follow up if you have more doubts.

Thank you.