Indu Subramanian, MD, a movement disorders neurologist in Los Angeles, explains how tracking medication timing, motor and non-motor symptoms, and safety risks can support better Parkinson’s care decisions.
Transcript
If you can track how accurate you are with your pill times, as well as when you are accurate with those pill times, how your motor symptoms fluctuate, as well as your non-motor symptoms fluctuate, it can be helpful.
Many people, as their disease advances, find that the pill may not last the full amount of time until they take their next pill, and that there’s sort of this reoccurrence of, let’s say, some things like stiffness, slowness, and tremor maybe an hour before their next dose.
If you can kind of track this — and we actually have a way to track it on a motor diary, which is something that you can print out from a website — you can track whether you’re in the on state, whether you’re in the off state (which means that your medicines aren’t working), if you’re in the on-with-dyskinesia state so that there’s extra movements happening at those times, or if you’re asleep. We can track this for the 24-hour cycle in 30-minute increments.
That sort of visual diary sometimes can be helpful to folks who are going to be adjusting your medicine.
There’s a ton of apps out there, but I think this motor diary on paper is still quite helpful to neurologists and other clinicians. And the other thing that I would say is, just in tracking symptoms, you know, when you think about these buckets, you have the motor bucket, the non-motor bucket, and then this sort of mental health and cognitive bucket. I think that each of these things can be tracked a little bit differently.
Some people have increasing non-motor issues that are quite significant. Another thing to track is, for example, weight, which we check when people come in. As people advance, sometimes their weight goes down, and this is something that is important.
So if you’re noticing that you or your loved one is living with Parkinson’s and is having a decline in weight as Parkinson’s is advancing, it’s important to bring that to the attention of your physician.
Other things that are important to bring to the attention and track are a few things. One is fall risk — tracking the number of falls you’re having per day, or per week, or per month.
Another is hallucinations — how often you are seeing things that aren’t there. Writing those things down is helpful to the physician. And then swallow risk — if you can track how often you’re choking, maybe on liquids or solids, writing down details about choking episodes. Those three things are actually very helpful.
