General measures
- Nicotine restriction (refraining from tobacco use).
- Alcohol abstinence (abstaining from alcohol
- Preservation of normal weight strive!Determination of BMI (body mass index, body mass index) or body composition by means of electrical impedance analysis and, if necessary, participation in a medically supervised program for underweight.
- Verification of driving license: with the diagnosis of idiopathic Parkinson’s syndrome (IPS), the fitness to drive is usually not given for holders of the driver’s license for motor vehicles of group 2 (truck, bus, cab). For holders of the driving license for motor vehicles of group 1 (cars, motorcycles, agricultural tractors), the fitness to drive can be given after individual assessment with successful therapy or in mild cases. (Expert consensus)
- Review of permanent medication due topossible effect on the existing disease.
- Avoidance of environmental stress:
- Cobald
- Disulfiram
- Carbon disulfide (CS2)
- Carbon monoxide
- Manganese
- Methyl alcohol (methanol)
- MPTP (1-methyl-1-4-phenyl-1,2,3,6-tetrahydropyridine)
- Organochlorine pesticides – e.g., beta-hexachlorocyclohexanes (beta-HCH) were more frequently detectable in patients with PD (76%) compared with a control group (40%)
- Cyanide
Possible therapeutic procedures
- Deep brain stimulation: deep brain stimulation (THS; synonym: deep brain stimulation; English : deep brain stimulation, DBS) in the subthalamic nucleus region is considered effective in PD patients with severe levodopa-induced motor complications; this usually occurs after 11 to 13 years of disease. Meanwhile, a study (EARLYSTIMM study) demonstrated that patients treated with THS at an early stage (4th to 8th year of disease) have a better quality of life than those receiving guideline-based pharmacotherapy.Guideline recommendation: bilateral electrical stimulation of the nucleus subthalamicus should be offered to patients with established idiopathic Parkinson’s disease (IPS)
- Who have any of the following disease manifestations:
- Motor fluctuations and dyskinesias (disturbance of the physiological movement of a body region or body part) that cannot be treated with medication; or
- Have a tremor (tremor) that cannot be controlled with medication
and
The therapy involves surgery and therefore special risks that must be weighed against the gain from the therapy individually.Side effects: In individual patients, neurostimulation causes the deletion of the ability to swim or ski; after switching off the neurostimulator, the ability to swim is restored.Deep brain stimulation in PD has shown in a double-blind randomized, Sham-controlled study INTREPID that under the therapy daily more symptom-free time and a significantly higher quality of life. Limitation: 5-year results, however, remain to be seen.
- Who have any of the following disease manifestations:
- Stem Cell Transplants: Research is currently underway to treat PD with stem cell transplants. Possibly, these will provide another therapeutic option in the future.
Vaccinations
The following vaccinations are advised:
- Pneumococcal vaccination
- Flu vaccination
Regular checkups
- Regular medical checkups
Nutritional medicine
- Nutritional counseling based on nutritional analysis
- Dietary recommendations according to a mixed diet taking into account the disease at hand. This means:
- A total of 5 servings of fresh vegetables and fruits daily (≥ 400 g; 3 servings of vegetables and 2 servings of fruits).
- Once or twice a week fresh sea fish, i.e. fatty marine fish (omega-3 fatty acids) such as salmon, herring, mackerel.
- High-fiber diet (whole grain products).
- Observance of the following special dietary recommendations:
- Diet rich in:
- Vitamins (B6, D, E)
- Trace elements (zinc)
- Omega-3 fatty acids (marine fish)
- Secondary plant compounds (eg beta-carotene).
- Coenzyme Q10
- Diet rich in:
- Selection of appropriate food based on the nutritional analysis
- See also under “Therapy with micronutrients (vital substances)” – if necessary, taking a suitable dietary supplement.
- Detailed information on nutritional medicine you will receive from us.
Sports Medicine
- Light endurance training (cardio training) and strength training (muscle training) – for prevention and therapy.
- Endurance training: up to four hours of exercise per week; after warming up, patients trained on a treadmill for 30 minutes to the limit of their performance (80 to 85 percent of their maximum heart rate): this initially slowed the progression of the disease in a randomized study (Unified Parkinson’s Disease Rating Scale (UPDRS): group with intensive training: minimal increase of 0.3 points; group with moderate training: increase 3.2 points).
- Endurance training seems to be particularly suitable to positively affect memory; however, a clear effect of training mode was not found; furthermore, coordination exercises were found to improve executive function (cognitive control) compared to control subjects without exercise.
- Treadmill training
- Strength–balance training for fall prevention (repetitive training of corrective support reactions).
- Preparation of a fitness or training plan with suitable sports disciplines based on a medical check (health check or athlete check).
- Detailed information on sports medicine you will receive from us.
Physical therapy (including physiotherapy)
- Patients with idiopathic Parkinson’s disease (IPS) should have access to physical therapy. Specific foci of treatment include:
- Gait training,
- Improvement/maintenance of balance,
- Strength and stretching exercises,
- Improving/maintaining aerobic capacity,
- Improvement/maintenance of exercise amplitudes,
- Improvement/maintenance of movement initiation,
- Improve/maintain mobility and independence in activities of daily living,
- Training of movement strategies,
- Fall prevention.
- Light therapy: up to 90% of people with Parkinson’s disease suffer from sleep problems usually associated with daytime sleepiness. With light therapy with bright daylight (10,000 lux, 5,000 K), patients showed improved sleep quality, fewer nocturnal awakenings and fewer problems falling asleep compared to the control collective (dim red light). This also led to a reduction in daytime sleepiness. Long-term studies are to be waited.
- Physiotherapy (here: Sensory cue training (cueing)/cognitive movement and “cueing” strategies; individualized pacing training designed to improve walking speed, stride length, and balance)Physical therapy designed to help patients maintain control over their movements has been shown to be ineffective in a randomized clinical trial in patients with early-stage disease.
Psychotherapy
- IPS sufferers should have access to psychotherapeutic treatment according to individual indications. The following methods were used within behavioral therapy settings (the following list is exemplary):
- Relaxation training (three studies).
- Cognitive behavioral therapy (CBT)* (five studies).
- Psychoeducation (five studies)
- * A Cochrane review found no evidence that cognitive training is helpful for people with PD and dementia or mild cognitive impairment (“MCI”) in PD.
- Detailed information on psychosomatics (including stress management) is available from us.
Complementary treatment methods
- Occupational therapy: patients with idiopathic Parkinson’s disease (IPS) should have access to occupational therapy treatment. Specific foci of treatment include:
- Maintenance of occupational and family roles, workplace, home care, and leisure activities.
- Improve and maintain transfers and mobility
- Improve and maintain autonomy in basic ADLs (such as eating, drinking, washing, and dressing) and IADLs (such as kitchen, household, and shopping activities).
- Environmental aspects to improve safety and motor activity.
- Cognitive approaches to improve specific daily functions.
- Occupational therapy designed to help patients maintain control over their movements has been shown to be ineffective in a randomized clinical trial in patients with early-stage disease.
- Speech and language therapy) – aimed at improving:
- Voice volume and range
- Swallowing behavior (logopedic swallowing therapy).
- Artistic therapy (music therapy, dance therapy, art therapy, or drama therapy) – may be considered for IPS patients. The therapy may be directed – depending on the content and objectives – to improve motor skills, voice or to activate resources, social participation and improve emotional well-being.
