Are there newer meds to manage my mom’s Parkinson's at 68?

Question

Hello doctor,

My 68-year-old mom was diagnosed with Parkinson's disease two years ago, and it is progressing faster than we expected. She started with just a slight tremor in her right hand, but now has trouble walking, and her voice is getting really quiet.

She takes Carbidopa-Levodopa 25/100 three times daily, but still has lots of stiffness, especially in the mornings. The neurologist added Ropinirole, but it makes her nauseous and gives her weird dreams about dead relatives. She has also developed depression since her diagnosis, which is not like her at all. She used to be very social, but now doesn't want to leave the house.

Her handwriting has gotten so small I can barely read her grocery lists, and she shuffles when she walks, which makes me afraid she will fall. Physical therapy helps, but insurance only covers 12 visits per year.

Parkinson's tremor gets much worse when she is stressed or tired, and she has trouble buttoning clothes or using silverware. Also worried because she lives alone, and what if she falls during the night? Are there newer medications that might work better? Also wondering about deep brain stimulation surgery and if that is safe for women her age.

Please help.

Thank you.

Answer 1

Hello,

Welcome to icliniq.com.

I can understand your concern.

I am really sorry your mom is going through this. It sounds like her Parkinson’s is significantly impacting her daily life, and I can understand your concern.

Carbidopa-Levodopa remains the most effective medication for motor symptoms, but as the disease progresses, adjustments in timing, dosage, or the use of controlled-release formulations are sometimes needed to smooth out stiffness and early-morning symptoms. Since Ropinirole is causing disturbing side effects, other options such as MAO-B (monoamine oxidase-B) inhibitors (like Rasagiline or Selegiline) or COMT (catechol-O-methyltransferase) inhibitors (like Entacapone) can be considered to extend the effect of Levodopa.

For her depression and social withdrawal, treatment is important; both antidepressant medications (such as SSRIs (selective serotonin reuptake inhibitors), if tolerated) and counseling support can make a difference, since mood changes are part of Parkinson’s itself, not just a reaction to the diagnosis.

The handwriting changes (micrographia), soft voice (hypophonia), and shuffling gait are very common, and physical therapy, along with speech therapy (for voice and swallowing), are key, even if insurance coverage is limited, some therapists may offer home exercise plans to maintain progress.

Regarding safety at night, fall-prevention strategies like removing tripping hazards, installing grab bars, and possibly using a medical alert system could provide peace of mind. As for deep brain stimulation (DBS), it can be highly effective in reducing tremor, stiffness, and motor fluctuations, but candidates are carefully selected; generally, people who respond well to Levodopa but experience disabling side effects or motor complications are considered. Age alone does not rule it out, but her overall health, cognitive status, and surgical risk would need careful evaluation by a movement disorders specialist.

It would be worth discussing these medication adjustments, therapy options, and DBS candidacy in detail with her neurologist, ideally one who specializes in Parkinson’s disease.

I hope this helps.

Kindly follow up if you have more concerns.

Thank you.