From the Guidelines
Patients with Parkinson's disease should be monitored routinely for nutritional status and malnutrition risk, as they are at increased risk of malnutrition and weight loss, with approximately 15% of community-dwelling patients with PD being malnourished and 24% at medium or high risk of malnutrition. The main symptoms of Parkinson's disease include tremor, muscular rigidity, bradykinesia, and postural instability, and as the disease progresses, other symptoms such as dysphagia, dysarthria, impaired gastrointestinal motility, and gastroparesis, fatigue, depression, and cognitive impairment may emerge 1.
Key Considerations
- Drug therapy is essential to control symptoms and maintain mobility in PD, and acts by replacing or mimicking dopamine in the brain.
- Several predictors of malnutrition have been found, including older age at diagnosis, higher levodopa equivalent daily dose/body weight, anxiety, and depression, and living alone.
- Dysphagia in PD usually occurs in the advanced phases of the disease, although sometimes it is present at onset, and functional alterations in oropharyngeal and esophageal motility can be present in about 60-80% of patients.
Management Approach
- Treatment typically involves medications like levodopa-carbidopa, which helps replace dopamine in the brain, and other medications such as dopamine agonists, MAO-B inhibitors, or COMT inhibitors may also be used.
- A balanced diet and regular exercise are essential complementary approaches to manage the disease and improve quality of life.
- Early treatment and a multidisciplinary approach involving neurologists, physical therapists, and sometimes speech therapists provide the best outcomes for managing this chronic condition, as noted in the espen guideline clinical nutrition in neurology study 1.
From the Research
Treatment Options for Parkinson's Disease
- Levodopa combined with carbidopa is still the most effective treatment for symptoms of Parkinson's disease 2
- Dopamine agonists, such as pramipexole and ropinirole, can be used alone before the introduction of levodopa or as an adjunct to levodopa 2, 3
- Pramipexole is effective as monotherapy in early Parkinson's disease and as adjunctive therapy in advanced disease 4, 5
Efficacy of Pramipexole
- Pramipexole has been shown to be effective in relieving motor symptoms (akinesia, rigidity, and tremor at rest) and non-motor symptoms such as depression in Parkinson's disease 4, 5
- Pramipexole may have neuroprotective properties, including dopamine autoreceptor agonist properties, antioxidant properties, and the ability to stimulate the release of trophic factors 5
Comparison of Pramipexole and Ropinirole
- A study comparing pramipexole and ropinirole in the treatment of Parkinson's disease found that both drugs were effective in monotherapy and levodopa add-on therapy, with significant improvements in motor symptoms and depression 3
- Pramipexole was found to have a significant improvement in Clinical Global Impression-severity of illness and Beck Depression Inventory scores in the levodopa add-on therapy group 3
Safety and Tolerability
- Pramipexole is generally well tolerated, but may be associated with a higher rate of some dopaminergic adverse effects compared to levodopa treatment 4
- Ropinirole and pramipexole have been found to be safe and effective in the treatment of Parkinson's disease, with similar efficacy and safety profiles 3