Parkinson’s Pathway notes to help with understanding and the training.

I. MEDICATION MANAGEMENT

• Parkinson’s medications must be taken exactly on schedule.
• Late or missed doses can cause “OFF” time: more tremor, slowness, and stiffness.
• Dyskinesias are extra, involuntary movements that can happen when medication levels are high.
• High-protein meals may reduce levodopa absorption in some people.
• Track patterns: Are symptoms worse right before the next dose? Write this down and report it to the MD.

II. MOVEMENT & EXERCISE

• Exercise acts like medicine for Parkinson’s disease.
• It improves gait, balance, mobility, confidence, and emotional wellbeing.
• Best results come when exercise is guided by a physical therapist (PT) familiar with PD.
• Use safe strategies:
• Clear hallways and remove clutter.
• Use gait belts when appropriate.
• Use mobility devices (cane, walker, wheelchair) as recommended.

III. NUTRITION

• Constipation is very common. A combination of fiber + fluids usually helps.
• Swallowing difficulty can develop as the disease progresses.
• Request a speech therapy evaluation if you notice coughing or choking during meals.
• Talk with the MD about protein timing if medications are not lasting as long or “wear off” too soon.

IV. EMOTIONAL SUPPORT

• Depression, anxiety, apathy, and cognitive slowing are common in Parkinson’s.
• Validate feelings and avoid minimizing symptoms (“You’re fine,” “It’s nothing”).
• Encourage:
• Social connection (visits, phone calls, support groups)
• Routines and hobbies that the person still enjoys
• Patience and calm communication from all caregivers
• Report suicidal thinking, major confusion, or new hallucinations to the MD right away.

STAGE-BASED GUIDANCE

A. EARLY STAGE

• Mild symptoms, usually on one side first.
• Medication response is generally good.
• Encourage regular exercise and safe movement habits.
• Monitor:
• Sleep
• Mood
• Constipation
• Driving safety
• Work and daily activity changes

B. MID STAGE

• Symptoms are now on both sides.
• Freezing of gait and falls are more frequent.
• “Wearing off” between doses and possible dyskinesias.
• Home modifications:
• Remove loose rugs
• Improve lighting
• Install grab bars
• Consider a raised toilet seat and shower chair

Therapies:

• PT for balance and gait
• OT for home safety and adaptive equipment
• Speech therapy for low voice and swallowing issues
• Call the MD if you notice:
• New or frequent choking or coughing with food
• Frequent falls
• Big behavior changes or new confusion

C. LATE STAGE

• High risk of falls; severe slowness and stiffness.
• May need a walker or wheelchair and help with most daily activities.
• Dizziness or fainting when standing (orthostatic hypotension).
• More cognitive changes and possible hallucinations or delusions.
• Significant swallowing difficulty, weight loss, or frequent infections.

Consider:

• Palliative care for symptom relief and caregiver support
• Hospice discussions based on overall decline and goals of care

NON-MOTOR SYMPTOMS

(OFTEN EARLY)

• Sleep problems
• Constipation
• Reduced sense of smell
• Pain and fatigue
• Slower thinking and memory changes
• These can appear years before obvious tremor or stiffness. Track changes—people may feel embarrassed to bring them up.

MOTOR SYMPTOMS

• Tremor at rest
• Rigidity (stiffness)
• Slow movement (bradykinesia)
• Shuffling gait
• Freezing episodes
• Reduced arm swing
• Masked facial expression (reduced facial movement)

KEY SAFETY REMINDERS

• Medication timing = function. Small delays can make a big difference.
• Encourage daily exercise within the person’s abilities.
• Monitor nutrition, hydration, and bowel health.
• Always validate feelings and protect dignity.
• Report major changes (falls, choking, sudden confusion, severe mood changes) to the medical team promptly.