My tremors worsen with rest. Has my Parkinson's progressed?

Question

Hello doctor,

I am a 67-year-old woman experiencing tremor in my left hand that is worse when resting, along with stiffness and significantly slower movement that has been progressively worsening over two years.

My DaT scan showed markedly reduced dopamine transporter binding bilaterally, more pronounced on the right side, and my response to Levodopa has been good, but is wearing off faster. I have developed a shuffling gait, my handwriting has become tiny (micrographia), and I am having trouble with balance and frequent falls.

My voice has become softer and monotone, and I am experiencing constipation and REM sleep behavior disorder.

Could this Parkinson's disease progress to dementia or Parkinson's disease psychosis?
Am I at risk for dangerous falls, swallowing difficulties, or becoming completely dependent on others for daily activities?

Kindly suggest.

Answer 1

Hello,

Welcome to icliniq.com.

I understand your concern.

From what you describe, symptoms like rest tremor, stiffness, slowness, good response to Levodopa (but with wearing-off), gait changes, micrographia, soft speech, constipation, and REM (rapid eye movement) sleep disorder fit very well with Parkinson’s disease.

Your DaTscan (dopamine transporter scan) also supports this. The risks associated with disease progression are:

As Parkinson’s advances, balance can worsen, and frequent falls are a major risk. Physiotherapy, balance training, and home safety measures can help reduce danger.
In later stages, difficulty swallowing (dysphagia) may occur, increasing the risk of aspiration and pneumonia. Early involvement of a speech therapist can help.
Some people with Parkinson’s eventually develop memory and thinking problems (Parkinson’s disease dementia). Risk is higher with older age and longer disease duration, but it does not happen to everyone.
Psychosis (hallucinations, delusions) can occur, often as a side effect of medications, especially at higher doses. Usually treatable with medication adjustments or specific drugs.
Over the years, patients become dependent and may need more help with daily activities. However, with proper treatment, therapy, and support, many remain independent for a long time.

You can manage your condition with the suggestions below:

Your wearing off can be managed with medication dose adjustments, extended-release formulations, or add-on therapies.
Physiotherapy for mobility, occupational therapy for daily skills, and speech therapy for voice and swallowing.
Regular exercise, a fiber-rich diet for constipation, and good sleep hygiene.
Regular follow-ups with your neurologist to anticipate complications early.

I hope you find this helpful.

For more queries, feel free to reach out to me anytime.

Thank you.