I am 68 with HTN and Parkinsonism. How to manage my tremors?

Question

Hi doctor,

I am a 68-year-old male diagnosed with Parkinson’s disease six years ago, currently on Carbidopa-levodopa 25/100 mg four times daily. Along with this, I have had hypertension for the past 10 years, managed with Amlodipine 5 mg daily. Over the last four months, I have noticed worsening tremors in my right hand, stiffness in my legs, and slowness in walking, causing me to take smaller steps.

My BP readings at home average 154/88 mmHg, and I sometimes feel lightheaded when standing up. I also experience fatigue, mild depression, and occasional vivid dreams at night. My wife has observed that I have episodes of talking in my sleep and sometimes acting out my dreams.

Recently, I have had two near-falls while turning corners, and my balance feels less stable. My latest blood tests showed normal kidney function but low vitamin D at 21 ng/mL. I exercise lightly three times a week, but my movements feel increasingly slow.

Please help.

Answer 1

Hi,

Welcome to icliniq.com

Your symptoms suggest that your Parkinson’s disease is progressing, as shown by worsening tremors, increased stiffness, smaller steps, and balance problems, while the near-falls indicate a higher risk of injury.

The vivid dreams, acting out during sleep, and talking in your sleep point to rapid eye movement (REM) sleep behavior disorder, which can be managed with medications and safety adjustments in the bedroom. The fatigue and mild depression are also common in Parkinson’s, which improve with medication review, mood support, and addressing your low vitamin D level through supplementation.

Your current blood pressure readings show suboptimal control, and the lightheadedness when standing may indicate orthostatic hypotension, which can occur in Parkinson’s or as a side effect of blood pressure or Parkinson’s medications, so your doctor may need to adjust your treatment. A neurologist will consider changing your Carbidopa and Levodopa dosing schedule, adding other Parkinson’s medications to smooth out symptom control, and referring you to physiotherapy for balance and gait training.

Close monitoring and a coordinated approach between your neurologist and primary care physician will help manage symptoms, improve mobility, and reduce fall risk.

I hope this helps.

Thank you.