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Social and emotional support. Social and emotional support is essential in people that have just been diagnosed with the disease, since coping with the diagnosis of a chronic and neurodegenerative disease is difficult. Patients have many questions and a good health education is essential to encourage self-care. Relatives and friends, together with the medical team, are an essential support for accepting the disease and living with it. In some cases, specialised psychological help may be necessary.
Diet. Diet is affected by the deficiencies in smell and taste, nausea, heavy digestions due to slow gastric emptying and constipation. The Mediterranean diet is recommended. Certain pulses and beans contain levodopa, but their benefit is uncertain. Ensure adequate hydration (minimum 1-2L daily), the addition of salt, and frequent small meals (minimum 4 per day) to help with heavy digestion, constipation, and low blood pressure. It is very important that the patient checks with a doctor if there are significant changes in weight, and on being a disease that brings about difficulty in mobility, overweight should be avoided.
Exercise. Physical exercise is important, but exhausting exercise must be avoided and it should be adapted to the possibilities of the patient. In case of motor fluctuations, it is worth making the most out of improvement periods. Recommended exercises are tai chi, tango, treadmills or elliptic machines, and cycling. Great care must be taken in patients with frequent falls. The most important point of exercise is that it is appealing to the patient so they can do it regularly.
Recommendations for sleeping well. Sleep hygiene (regular sleeping hours, do not eat too much before going to bed, reserve the bed only for sleeping, do not have long afternoon naps or go to bed too late, avoid stimulating substances) is always the measure against nocturnal insomnia and drowsiness during the day. Other more general recommendations to sleep well are the use of a hard mattress, comfortable pyjamas, bed-rails in case of a REM sleep disorder, or when it is difficult to move in bed, remove hard or sharp objects in case of involuntary movements that may result in injury. Pharmacological treatment must be reserved for when these measures are insufficient.
Sexuality. Sexuality may be affected by symptoms such as erectile dysfunction, vaginal dryness, depression, or motor difficulty. A visit to the urologist can help to rule out other diseases and start medication or other therapeutic measures, as well as lubricants, in the case of women. In other cases, there may be hypersexuality as a side effect, particularly by dopaminergic agonists, that require drug adjustments.
Toxic habits. Excessive consumption of alcohol and tobacco must be avoided, due to the effects on the peripheral nerves or the cardiovascular system that make the mobility problems worse.
Travel. To travel as a passenger (public transport, plane, ship) is not contraindicated for Parkinson’s disease in itself. It is advisable to always carry the medication and the medical reports, particularly in carriers of devices such as deep brain stimulation. As regards driving, the recommendations of the General Department of motor vehicles is to stop professional driving, whilst private driving can still be performed in the initial phases. Alcoholic drinks must be avoided, as well as driving during rush hours, and night driving.
How to alleviate the side effects
Nausea or gastric discomfort. If the effects are mild, it is recommended to take the dopamine medication after food. If this does not work, drugs such as domperidone can be also taken. It should be remembered that drugs like metoclopramide are contraindicated.
Motor fluctuations. These are chronic complications that can be alleviated by adjusting the medication. A common type of adjustment is usually to take the medication in shorter intervals in order to make the drug more available, or combine several dopaminergic drugs. if these measures are insufficient and the fluctuations are severe, the type of advanced treatment will be assessed (surgery, intestinal levodopa, or subcutaneous apomorphine) to select the most suitable to improve the symptoms and the quality of life of the patient.
Visual hallucinations, delirium and other behavioural changes. This normally occurs in older patients and in cognitive impairment. In these cases, attempts should be made to reduce the medication and/or add symptomatic treatments, such as the neuroleptics (quetiapine, clozapine).
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Substantiated information by:
Almudena Sánchez Gómez
Ana Cámara Lorenzo
Maria José MartíHead of the Parkinson's and Movement Disorders Unit
Yaroslau Compta Hirnyj
Published: 8 July 2019
Updated: 14 November 2019
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