From the Guidelines
To improve motor function in patients with Parkinson's disease, advising them to comply with a protein-redistribution dietary regimen is recommended, in addition to taking levodopa medications at least 30 minutes before meals. This approach is based on the strongest and most recent evidence from the espen guideline clinical nutrition in neurology study 1, which suggests that maximizing levodopa absorption and efficacy can be achieved through dietary adjustments.
Key Recommendations
- Advise PD patients to take levodopa medications at least 30 minutes before meals to avoid interactions with dietary large neutral amino acids 1.
- Recommend a protein-redistribution dietary regimen for patients experiencing motor fluctuations, which involves consuming a low-protein breakfast and lunch, and a second course with no quantitative restrictions on protein only at dinner 1.
- Monitor patients actively to avoid potential complications such as weight loss, micronutrient deficits, hunger before dinner, and dyskinesias 1.
- Set daily protein requirements to 0.8-1.0 g/kg of body weight to meet nutritional needs 1.
Rationale
The protein-redistribution dietary regimen is based on the principle that levodopa competes with dietary large neutral amino acids for intestinal absorption and transport across the blood-brain barrier 1. By reducing protein intake during the day and consuming it mainly at dinner, patients can maximize levodopa absorption and efficacy, leading to improved motor function and disability 1. This approach is particularly beneficial for patients in the early stages of PD and those with onset of PD at a younger age 1.
Additional Considerations
- Patients should be advised to distribute food intake throughout the day and divide protein intake when treated with continuous duodenal duodopa 1.
- In tube-fed patients, enteral nutrition should be interrupted for at least 1 hour before and 30-40 minutes after drug administration to minimize interactions 1.
From the FDA Drug Label
According to the provided drug labels, there is no direct information that supports other measures to improve motor function in patients with Parkinson's disease (PD) aside from the use of the mentioned medications.
The FDA drug label does not answer the question.
From the Research
Measures to Improve Motor Function in Patients with Parkinson's Disease
Other measures to improve motor function in patients with Parkinson's disease (PD) include:
- Physical therapy and complementary exercises, such as gait training with cues, gait training with treadmill, Nordic walking, brisk walking, balance training, virtual reality interventions, Tai Chi, and dance 2
- Forced exercise cycling, which may be safely added as an ancillary therapy to the medical management of PD 3
- Non-invasive brain stimulation (NIBS), which has shown small-to-moderate benefits for motor symptoms and functional movement in PD 4
- Group exercise, which has a similar to larger effect as individual exercise and usual care on improving motor function and mobility for people with PD 5
- Exercise and rehabilitation therapy, which can improve motor function and quality of life in individuals with PD, and may reduce the risk of hospitalization 6
Types of Exercise and Therapy
Some specific types of exercise and therapy that have been shown to be beneficial for patients with PD include:
- Gait training with treadmill, which can enhance walking performance and sustain effects for 3-6 months 2
- Balance training, which can improve balance, function, and reduce fall rate, with effects carrying over to at least 12 months after training ended 2
- Tai Chi, which can alleviate PD motor symptoms when sustained for 6 months 2
- Dance therapy, which can alleviate PD motor symptoms when sustained for 12 months 2
- Progressive resistive training, which can alleviate PD motor symptoms when sustained for 24 months 2