Parkinson Disease (PD): How to Manage 'On' and 'Off' Symptoms

7 Tips to manage Parkinson symptoms

Plan for your daily activities

'Off' state occurs when the effects of Parkinson medication begins to wear off, making it difficult for Parkinson sufferers to function.

For some Parkinson patients who have been on medication for several years, they may experience fluctuation of symptoms in between medication doses, known as the ‘on’ and ‘off’ phenomenon.

Senior Nurse Clinician Li Wei, an Advanced Practice Nurse from the National Neuroscience Institute (NNI), a member of the SingHealth group, shares tips to manage symptoms.

What is 'on' state?

With medication, the Parkinson patient functions well with good control of symptoms such as tremors, stiffness and slowness.

What is 'off' state?

When the effects of the medication begins to wear off, symptoms return and makes it difficult for the Parkinson patient to function.

7 Tips to manage Parkinson symptoms

To better manage Parkinson disease (PD) symptoms, Senior Nurse Clinician Li Wei offers the following advice for patients:

1. Stay positive and be aware that Parkinson's can affect your mood

2. Recognise the 'off' symptoms of Parkinson's disease (PD) and keep a symptom diary

3. Discuss with your PD specialist doctor and nurses if you need help coping with new symptoms. They can adjust your care plan to suit your needs

4. Take your medication regularly and stick to the prescription. This will help you have better control of symptoms

5. Plan your daily activities around ‘on’ and ‘off’ states (see an example below) — do activities that require more energy during the ‘on’ state

6. Exercise regularly to remain strong and sleep better

7. Take part in social activities and keep your spirits up

Plan for your daily activities

Madam Guo, a 55-year-old who has been living with Parkinson's disease (PD) for over a decade, shares how she plans her daily activities according to her 'on/off' timings.

Time	Activity
5am 'Off' state	Wake up Perform religious rituals Read scriptures aloud, which helps with voice training Measure blood pressure
6.30am	Take medication Wait for medication to activate (about 15 to 30 minutes, but can be unpredictable)
7am 'On' state	Eat breakfast, consisting of fruits and eggs (meal at 30 minutes after taking medication to ensure effectiveness of medication) Exercise at home (cycling, taichi and exercises recommended by physiotherapist) Drink juice Measure blood pressure Pack food for distribution at temple Flower arrangement
11.30am 'Off' state	Rest Watch television Listen to music Do stretches to relieve muscle cramps
12.30pm	Take medication
1pm 'On' state	Eat lunch Shower Continue packing food for the temple Buy groceries Drink protein shake
4pm 'Off' state	Rest Watch television Read scripture Watch informative public forums online
5.45pm	Take medication
6.15pm 'On' state	Eat dinner Drink juice Household chores Watch television Drink protein shake
9pm	Bedtime