Patients with Parkinson’s disease must remember to stick with their complicated medication regimen to better manage their condition.

Medication plays an important role in the treatment of Parkinson’s disease (PD). It is common for patients with PD to take a variety of medications as frequently as five to eight times a day, with some at strict and specific time intervals.

Associate Professor Prakash Kumar, Head of Neurology, Sengkang General Hospital, and Senior Consultant, Department of Neurology, National Neuroscience Institute (NNI), estimates that at least one out of three patients with PD have problems taking their medicine on time. This can pose serious issues, as symptoms can re-emerge within 30 minutes of a missed dose, affecting the patients’ daily activities.

A progressive disease

PD is caused by the degeneration of brain cells that produce important neurochemicals like dopamine.

Dopamine transmits messages from the brain to control movements. This is why patients with PD commonly experience movement-related issues, such as uncontrollable shaking in their limbs when they are resting, unnaturally slow movement, stiffness, and difficulty balancing when they walk or stand. Some patients also have problems swallowing and suffer from sleep issues, depression and constipation.

In Singapore, three in 1,000 people above 50 years old suffer from PD. This is set to increase by 2030 due to the ageing population and increased life expectancy.

PD can affect individuals of any age, although it is more commonly diagnosed in those aged 50 years and above.

According to Prof Prakash, about five per cent of patients with PD in Singapore are below 50 years old — a condition known as young-onset Parkinson’s disease. Currently, there are no conclusive tests to diagnose this condition, and a detailed examination by a neurologist is required to confirm the diagnosis.

Generally, the disease progresses in five stages. At the first stage, symptoms are mild and patients can carry out their daily activities with minimal difficulty. As the condition progresses into the second stage, tremors and stiffness may affect both sides of the body, and patients may take longer to perform their activities.

At the third stage, patients experience balance and gait issues, and may even suddenly find themselves being unable to move while walking. They may also fall more easily due to balance issues. By the fourth stage, most individuals will rely on mobility devices to get around. At the fifth stage, patients become bed- or wheelchair-bound.

“On average, the disease takes eight to 10 years to progress from early to advanced stage. Some patients may remain active for up to 20 years even after diagnosis, while some may experience a faster deterioration,” Prof Prakash said.

Timely medications

The medicine for PD patients can be broadly classified into two categories — levodopa-containing agents and levodopa-sparing agents.

Levodopa-containing agents, including medicines like Madopar and Sinemet, are known to be effective in improving patients’ symptoms, such as stiffness in the neck, limbs and body, and slowness of movement.

On the other hand, levodopa-sparing agents, such as Selegiline and Ropinirole, are usually used to treat younger patients in the early stages of the condition.

“As the disease progresses, patients may require a higher dosage, more frequent doses, or a combination of medications to help them manage the condition,” Prof Prakash said.

Levodopa-containing medications are to be taken one hour before meals. If patients choose to have their meals first, they must wait for at least two hours before they take their next dose of medication.

Explaining the reason for the complex medication regimens, Prof Prakash said, “If the medicine is taken together or very close to mealtimes, the food, which contains protein, drastically affects the absorption of medicine in the intestines. This significantly reduces the efficacy of the medicine, and consequently its effects on the brain cells.”

There is currently no cure for PD; medication can only help alleviate symptoms. Patients may also be prescribed physiotherapy, occupational therapy and speech therapy to help them cope with their daily activities.

By adhering closely to the medicine schedule and prescribed exercises, caregivers and patients can better control the symptoms and disease progression to make living with PD more manageable.

Digital aid

To remind patients to take their medications on time and monitor their symptoms, NNI has developed Parkinson’s Care, a new feature on the SingHealth Health Buddy app. Users can make use of the following functions:

• Symptom trackers — monitors and records symptoms, such as when the effects of medication wear off, body discomfort (aches, cramps), bowel movements and sleep patterns

• My Goals — allows patients to set simple goals, such as doing three short exercises a day

• My Exercise Diary — contains videos and guides demonstrating exercises useful for patients with PD

• Medicines Reminder — patients can key in medicine timings to receive timely reminders

• Appointment Reminder

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