How to manage worsening Parkinson's symptoms in my father?

Question

Hello doctor,

My father is 72 and has Parkinson’s disease, diagnosed four years ago. He is on Carbidopa or Levodopa 25 and 100 mg four times daily, but he is now experiencing wearing-off and occasional dyskinesia. His neurologist suggested adding Entacapone or considering a Dopamine agonist. We are looking for your opinions on:

What are the pros and cons of each option, especially considering his age?
Also, how do we delay further progression?
Do supplements like CoQ10 or exercise have any proven benefit?
He is getting forgetful. Could it be medication-related or early dementia?
Should we see a movement disorder specialist or get cognitive testing done?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

Your father's experience with wearing-off and dyskinesia after several years on Carbidopa or Levodopa is a common progression in Parkinson’s disease. Adding Entacapone, which is a COMT (catechol-o-methyltransferase) inhibitor, can help extend the effect of each Levodopa dose by reducing its breakdown, which will smooth out motor fluctuations without significantly increasing the risk of side effects.

Dopamine agonists like Pramipexole or Ropinirole can also reduce off-time and Levodopa dependence, but in older adults, they carry a higher risk of side effects such as hallucinations, daytime sleepiness, impulse control disorders, and confusion.

Given your dad’s age and early cognitive symptoms, Entacapone will be the safer first step. His increasing forgetfulness is related to Parkinson’s disease itself, as mild cognitive impairment and eventual dementia are not uncommon, but it could also be exacerbated by medication effects or other medical issues.

A comprehensive cognitive assessment and possibly a consultation with a movement disorder specialist would be valuable to clarify the cause and guide management.

In terms of slowing progression, while no treatment has definitively been proven to halt the disease, regular aerobic exercise has shown strong evidence in improving motor function and possibly delaying decline.

Supplements like CoQ10 have not shown consistent benefit in large trials but are generally well tolerated if used as an adjunct.

I hope this helps.

Thank you.