My father, 64, has worsening Parkinson tremors. What to do?

Question

Hi doctor,

My father is 64 years old and was diagnosed with Parkinson’s disease three years ago. He is currently on Syndopa Plus and Rasagiline, but his tremors and slowness seem to be worsening. Lately, he has also been having difficulty with balance and mild visual hallucinations.

Is this disease progression, or could it be a medication side effect? Should his regimen be adjusted to include an extended-release form or a dopamine agonist?

Please advise.

Answer 1

Hi

Welcome to icliniq.com

Your father’s symptoms can result from both disease progression and medication effects. Parkinson’s disease naturally worsens over time, leading to increased tremor, slowness, and balance issues as dopamine levels continue to fall. However, the visual hallucinations are often related to dopamine medication side effects, especially at higher doses or with longer use.

Here’s how we usually approach this stage:

Review medications carefully. Sometimes reducing or adjusting the timing of Syndopa (Levodopa/Carbidopa) or Rasagiline helps lessen hallucinations.
Extended-release Levodopa preparations or fractionated smaller doses can help smooth out fluctuations and reduce “wearing-off” symptoms.
Add-on drugs like dopamine agonists (Pramipexole, Ropinirole) or Catechol-O-methyltransferase enzyme inhibitors like Entacapone, Opicapone may be used if the main problem is short-duration benefit, but these can worsen hallucinations, so must be used cautiously.
If hallucinations persist, mild antipsychotics safe in Parkinson’s (like Quetiapine or Pimavanserin) may be needed under supervision.
Balance problems often benefit from physiotherapy and gait training, since medications alone may not correct postural instability.

In short, yes, this could be a mix of progression and medication effect. A neurology review to fine-tune doses, consider extended-release Levodopa, and reassess the need for dopamine agonists is recommended.

I hope this answers your query.

Thank you.