Treatment challenges in early stage Parkinson's disease

Most patients experience a sense of shock and dismay after being told that they have PD. The impact of this diagnosis is profound in younger individuals who are employed or have major domestic responsibilities. For this reason, it is important for the clinician to provide psychologic support and up-to-date information about the disease and to emphasize the benefits of current therapy and the promise of more effective therapeutic strategies in the near future. The clinician should attend to signs of depression, anxiety, and cognitive impairment. The choice of pharmacotherapy depends on the patient's age, cognitive status, employment, disease status, domestic responsibilities, and side effects that may interfere with the patient's lifestyle. In general, relatively young individuals are at greater risk for developing dyskinesia and motor fluctuations and may have fewer of these side effects if treated with dopamine agonists. However, nearly all patients eventually require L-dopa. Unfortunately, L-dopa wears off and induces dyskinesia and motor fluctuations with long-term use. Research into other PD drugs that might provide symptom benefit in early PD patients without long-term adverse consequences is needed. Although neuroprotective therapy is in its infancy, there has been a major shift on the part of the National Institutes of Health and the pharmaceutical industry to fund research on neuroprotective strategies for this debilitating disease. It is hoped that the long search for drugs that slow the progression of PD will come to fruition in the near future and enable our patients to look forward to a more normal and productive life.