​No two persons with Parkinson (PwP) will have the same set of symptoms. However, some will experience what are known as the ‘on’ and ‘off’ states. Learning to manage this is key in controlling symptoms and maintaining quality of life.


Parkinson disease (PD) affects the nervous system that controls movement. There is no cure and it gets worse over time, but treatment can help manage some of the symptoms. However, after a few years of taking medication, some patients experience fluctuation of symptoms in between medication doses, known as the ‘on’ and ‘off’ phenomenon.

Motor (movement) symptoms are the main signs of PD. These include the four S’s:

  • shaking
  • slowness
  • stiffness
  • stability impairment (poor balance)

Besides motor symptoms, PwP also experience:

  • depression
  • constipation
  • postural hypotension (drop in blood pressure when standing up from sitting or lying down)
  • fatigue
  • smell impairment
  • urinary symptoms (urinary urgency, frequent urination)
  • cognitive changes
  • sleep disorder (excessive day time sleepiness, acting out of dream)


  •  With medication, a PwP functions well, with good control of symptoms, such as tremor, stiffness and slowness.
  • Starts around 30 to 45 minutes after taking medication and can last a few hours, depending on the individual and stage of the disease.


  • When the effects of the medication start wearing off, symptoms return.
  • PwP may find it more difficult to walk and move, and can also experience mood changes, anxiety and restlessness.
  • Usually happens before the next dose of medication is due.

Planning activities according to the medication ‘on/off’ timings helps to reduce stress and frustration that can result from living with PD.

Professor Louis Tan, Senior Consultant, Department of Neurology and Parkinson Disease & Movement Disorders Programme Director at NNI, explains, “Initially, transition from the ‘on’ to ‘off’ state is gradual and predictable. However, as the disease progresses, it may occur more frequently throughout the day. Patients should seek medical advice to address this.”

This article first appeared in NeusLink Issue 14 - click to download!

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