My father 69 has Parkinson's. Are there new therapies?

Question

Hi doctor,

My 69-year-old father was diagnosed with Parkinson's two years ago and is declining much faster than expected. His tremors are so severe that he cannot feed himself or button his shirts anymore. The Carbidopa-Levodopa helps somewhat but causes unpredictable freezing episodes where he cannot move at all.

He has fallen six times this past month, and his voice is so quiet we can barely hear him, which frustrates everyone. Sleep is terrible with violent nightmares where he acts out dreams and accidentally hits my mother. The specialist mentioned deep-brain stimulation, but we are scared about the risks at his age. He is becoming deeply depressed about losing independence and being a burden on our family.

Are there any newer medications or therapies that might slow progression or improve symptoms better? We want to preserve his dignity and quality of life as long as possible.

Please help.

Answer 1

Hi,

Welcome to icliniq.com.

I understand your concern.

This sounds like a very challenging situation. Your father has advanced Parkinson’s disease, with severe tremors, freezing episodes, frequent falls, significant voice changes, sleep disturbances, including rapid eye movement (REM) sleep behavior disorder, and marked loss of independence.

While Carbidopa-Levodopa remains the most effective symptomatic treatment, advanced Parkinson’s often brings complications like motor fluctuations, dyskinesias, and unpredictable “off” periods, which you are already seeing.

There are several approaches to consider. Medications such as

Dopamine agonists (Pramipexole, Ropinirole).
Monoamine Oxidase B (MAO-B) inhibitors (Rasagiline, Selegiline).
Catechol-O-methyltransferase (COMT) inhibitors (Entacapone, Opicapone).

These medications can sometimes help reduce off periods or smooth out levodopa effects, though they may be limited at his age and can cause side effects.

Amantadine may help with dyskinesias and tremor in some patients. For freezing of gait, physical therapy, cueing strategies, and occupational therapy can be very helpful. Speech therapy, like Lee Silverman Voice Treatment (LSVT LOUD), can improve voice volume and communication.

For sleep disturbances and acting out dreams, your neurologist may consider Melatonin or low-dose Clonazepam, carefully balancing fall risk.

Advanced therapies include deep-brain stimulation (DBS) or continuous levodopa intestinal gel, but at 69, DBS carries higher surgical risks, especially if there are cognitive or medical comorbidities.

Newer medications, such as adenosine A2A receptor antagonists (Istradefylline), can reduce off-time when added to levodopa. Importantly, addressing depression and quality of life is essential, with psychiatric support, counseling, and sometimes medications like selective serotonin reuptake inhibitors (SSRIs).

Multidisciplinary care, including neurology, physical and occupational therapy, speech therapy, and nursing support, is critical to preserving independence and dignity. While no therapy currently slows disease progression, careful symptom management can significantly improve daily function and safety, and planning home modifications can reduce fall risk.

I hope my answer is clear to you, and if you need any details at any time, I am here and at your service.

Thank you.