Parkinson's disease can impact your nerve cells that control movement. This chronic condition usually starts slowly then can progress.
The progression of your Parkinson's is specific to you. You may not have all the symptoms, they may appear in any order, or your symptoms may not be as intense as someone else's.
Advanced-Stage Parkinson's Disease
Your doctor divides Parkinson's into five stages. Stages 4 and 5 are considered "advanced" Parkinson's.
You might also have cognitive problems as a result of your Parkinson's. Cognitive changes can affect your:
- Thinking
- Memory
- Planning
- Problem-solving
- Attention span
Sometimes these symptoms are mild, but other times, they can progress to dementia.
What Can a Neurologist Do?
A doctor who specializes in treating Parkinson's is a general neurologist or one with extra training in movement disorders.
Your specialist will also track your Parkinson's symptoms and disease progression. They can prescribe and adjust your Parkinson's medication, too.
Where to find a movement specialist
If you live in a rural area, you may not have a movement specialist nearby. You might need to travel a couple of times a year to a more populated area. This specialist can help you manage appointments with your general neurologist or primary care doctor.
Telehealth is another way to see a movement disorder specialist. Ask your doctor or a support organization about how to connect. Your doctor can conduct a virtual visit on your smartphone, tablet, or computer.
The International Parkinson and Movement Disorder Society maintains an online database to help you look for a specialist near you.
How Can a Mental Health Specialist Help?
If your Parkinson's affects your mental health, you're not alone. Nearly half of people with Parkinson's deal with anxiety and depression.
Depression may be a reaction to your Parkinson's diagnosis, but for some people, it's also a key part of the illness. Experts don't fully understand the relationship between Parkinson's and depression.
Anxiety can also be a reaction to a Parkinson's diagnosis, but you have also dealt with anxiety before.
Many people with Parkinson's feel apathetic – indifferent, not interested in activities, or unmotivated to take part. You can also get personality changes or psychosis.
Mental health and counseling benefits
If any mental health problems change the way you live day to day, a mental health provider can help. They can offer counseling, medication, and strategies to ease symptoms.
And their input can improve your quality of life – and that of your caregiver, too. Working with a mental health specialist can do more than just help your mood.
The connection is still unclear between mental health struggles and worsening Parkinson's symptoms. But addressing your mental health problems may help slow your disease progression.
How Can a Physical Therapist Help?
Because Parkinson's is a movement disorder, physical therapy can help you manage your condition.
In the early stages of Parkinson's, physical therapy can help you walk, balance, and move better (improve your range of motion). Some research suggests it can also help slow disease progress.
One physical therapy program specifically designed for people with Parkinson's is called LSVT BIG.
You can ask your doctor to help you find a physical therapist trained in Parkinson's. You also can call the Parkinson's Foundation help line at 800-4PD-INFO (800-473-4636).
How Can a Speech Therapist Help?
A speech therapist can help you prevent problems speaking and swallowing.
Speech problems
That's because Parkinson's can cause problems with speaking, such as:
- Trouble making specific sounds
- Slurring
- Lack of volume
- Hoarseness
- Sounding monotone
- Slow speech
Problems swallowing
Many of the same muscles you use for speaking also work to help you swallow. More than three-quarters of people with Parkinson's also have problems swallowing. This can lead to:
- Trouble taking your medicine
- Malnutrition
- Aspiration of food, saliva, or other liquids into your lungs, causing pneumonia
- Drooling, which happens when you don't swallow saliva automatically
Speech therapy benefits
A speech therapist can help you:
- Exercise to strengthen the muscles used in speech and swallowing
- Learn techniques to help you speak more clearly
- Use devices to help you communicate better
- Save your energy in ways that help you communicate better
Studies have found that intense speech therapy programs are especially helpful for people with Parkinson's.
You can also have mental symptoms that make it harder to communicate or understand what others are saying. With later-stage Parkinson's, you can have trouble recalling words or reading someone else's emotions.
A speech pathologist with special training can help with this as well. You can ask your movement disorder specialist or a support group for help finding a speech therapist.
How Can an Occupational Therapist Help?
An occupational therapist (OT) focuses on helping you do activities that are important to you.
Adaptive devices can also help you navigate your daily activities.
An occupational therapist can assess your living situation to suggest changes to make it safer and easier for you to function. They can help you rearrange furniture, for instance.
If Parkinson's makes it harder to do an activity you enjoy, your OT may be able to help. They can teach you to adapt to an activity using your current abilities.
How Can a Neurosurgeon Help?
A neurosurgeon can help you decide if deep brain stimulation (DBS) is right for you. This surgery can treat Parkinson's by working on certain symptoms, but it's not right for everyone.
In DBS, a team led by a neurosurgeon implants an electrical device in your brain. They'll also put a controller under your skin that sends pulses of energy to your brain. Those pulses block any problematic nerve signals to help ease Parkinson's symptoms.
How Can a Neuropsychologist Help?
While a regular psychologist concentrates on your mood and emotions, a neuropsychologist looks at how your brain functions.
A neuropsychologist can help you decide if you're a good candidate for DBS. They'll conduct extensive tests to see if the surgery is right for you.
But you don't have to get DBS to see a neuropsychologist. If your Parkinson's causes problems with thinking, they can assess how serious the issues are.
They'll identify problems with attention span, memory, and use of language. A neuropsychologist can also help guide other specialists on your treatment team.
What Other Specialists Might You Need?
You might also need to see a specialist that treats your eyes, and your stomach and intestines.
Parkinson's may impact your digestive system, which can lead to constipation and other problems. A gastroenterologist can help ease your symptoms.
Parkinson's can affect your eyesight and cause double vision. An ophthalmologist that specializes in eye care can help.
Don't Forget Your Primary Care Provider
Your regular doctor can still play an important role in managing your Parkinson's. Be sure to follow up and see them regularly.
They know you best and are familiar with your history. Your primary care doctor can help you manage your health overall, including unrelated conditions.
Your doctor can also help coordinate care among all your specialists to manage advanced Parkinson's.
Show Sources
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SOURCES:
Mayo Clinic: "Parkinson's disease."
Parkinson's Foundation: "Stages of Parkinson's," "Physical Therapy and PD," "Drooling," "Occupational Therapy and PD," "Assistive Technology and Devices," "Deep Brain Stimulation (DBS)."
Temple Health: "Newly diagnosed with Parkinson's disease? Here's what you need to know."
Johns Hopkins Medicine: "What to look for in a Parkinson's care team."
American Parkinson's Disease Association: "How Parkinson's Disease is Diagnosed," "What Does a Movement Disorders Specialist Do?" "Mental Health & Parkinson's," "Falls, Extreme Immobility, and Secretion Management."
The Michael J. Fox Foundation for Parkinson's Research: "Movement Disorder Specialists."
International Parkinson and Movement Disorder Society: "Find a Movement Disorder Specialist."
Lancet Regional Health – Europe: "The impact of psychiatric comorbidity on Parkinson's disease outcomes: a systematic review and meta-analysis."
Brown University Health: "Physical Therapy for Parkinson's Disease," "Parkinson's Disease and How Speech Rehabilitation Can Help,"
BMC Neurology: "LSVT-BIG therapy in Parkinson's disease: physiological evidence for proprioceptive recalibration."
Cleveland Clinic: "Tips for Improving Communication in People with Parkinson's Disease."
NYU Langone Health: "Deep Brain Stimulation for Parkinson's Disease."
Applied Neuropsychology (Adult): "Role of clinical neuropsychology in deep brain stimulation: Review of the literature and considerations for clinicians."
Hartford Health Care: "How a Neuropsychologist Can Assess Cognitive Symptoms of Parkinson's."
The Neuroscience Research Institute: "What Should You Expect from Your Primary Care Physician in Helping You Deal with Parkinson's?"
