Worsening Parkinson’s Disease and Associated Triggers

Medically reviewed by Smita Patel, MD

Parkinson's disease (PD) is progressive, meaning symptoms such as slow movement, tremors, and stiffness worsen over time. As the condition advances, full-time caregiver assistance is eventually required as mobility becomes minimal and symptoms turn severe.

The good news is that medication can control symptoms well, especially in the early stages. Likewise, lifestyle interventions can minimize factors, like physical inactivity, dehydration, and stress, that may aggravate PD symptoms or worsen disease progression.

This article will review the factors that may worsen Parkinson's disease and what you (or a loved one) can do to minimize these triggers.

Triggers That Worsen Parkinson’s Disease

Parkinson's is a highly complex disease, and experts aren't sure of the exact processes by which it develops.

Advancing age is the most significant risk factor for Parkinson’s disease, but genetic and environmental (outside or external) factors are also thought to be involved.

Genes

Even though most cases of Parkinson's disease are not directly inherited, multiple genetic mutations (alterations in DNA sequence) have been connected to Parkinson's disease.

This suggests that a person's genetic makeup may make them more or less vulnerable to developing PD. Genetic factors can also possibly affect disease progression.

Related: Genetics Testing in Parkinson's Disease

Modifiable vs. Unmodifiable Triggers

While exploring PD genetics is important for understanding the disease, a person's DNA cannot be changed. Environmental factors, though, can be altered, which may help prevent, delay, or improve PD symptoms.

Environment

Environmental factors linked to an increased risk for Parkinson's include:

• Exposure to agricultural pesticides, air pollution, and industrial solvents

• Metals in drinking water (e.g., copper, iron, and lead)

• History of a head injury

• Rural living

• Insufficient water intake

Research also suggests that stressful life events, physical inactivity, and certain dietary patterns can increase PD risk, worsen symptoms, and contribute to greater disability.

Related: Causes and Risk Factors of Parkinson’s Disease

How to Minimize Parkinson’s Triggers

There is no definitive way to prevent or slow the progression of Parkinson's disease. However, several studies suggest that healthy lifestyle behaviors could help minimize the impact of the disease and its symptoms.

Exercise

Participating in a safe, enjoyable exercise routine is a powerful tool for managing symptoms and possibly slowing down the disease.

In one Dutch study, 130 participants with mild Parkinson's disease were randomized to undergo aerobic or stretching exercises. The exercises were performed at home (delivered via a supervised web-based system) for 30 to 45 minutes three times a week for six months.

Study findings revealed that compared to the participants who performed the stretching exercises, those who underwent the aerobic exercise intervention had significantly reduced motor symptoms (those related to movement and balance).

In addition to motor symptoms, emerging studies have also discovered that exercise effectively reduces cognitive decline in Parkinson's disease.

Related: Home Exercises for Parkinson’s Disease

Diet

If you or a loved one has PD, you might adopt a "brain-nourishing" diet like the Mediterranean diet. The key ingredients of the Mediterranean diet are fruits, vegetables, olive oil, whole grains, nuts, legumes, and a moderate consumption of oily fish (e.g., sardines, mackerel, and salmon).

These foods are high in omega-3 fatty acids and flavonoids (chemicals with anti-inflammatory and antioxidant properties).

Learn More: Eating Flavonoid-Rich Foods May Help People With Parkinson's Live Longer

Fruits and vegetables are also rich in vitamins A, B (riboflavin), C, and E; interestingly, these vitamins' levels are low in some people with PD.

While more investigation is needed, experts suspect the Mediterranean diet is neuroprotective in PD, meaning protecting against the damage and death of dopamine-producing nerve cells. The death or impairment of these nerve cells leads to Parkinson's disease.

Caffeine and Tea

Several studies have found that consuming moderate amounts of black or green tea, has a beneficial effect on Parkinson's disease, such as improving cognitive (thinking and memory) function.

Incorporating caffeine (from green tea or another source) into your daily routine is also believed to be neuroprotective. One study found that regular caffeine consumption in people with PD significantly lowered their rate of disease progression.

Water

Water is vital for life, but in Parkinson's disease, problems swallowing (dysphagia) or age-related decline in thirst sensation can easily lead to dehydration.

Without adequate water intake, PD symptoms like constipation can worsen. Moreover, dehydration in Parkinson's disease is linked to an increased risk of deterioration.

Speak with a healthcare provider about how much water you should drink to maintain sufficient hydration based on your activity level and other medical conditions.

Stress Management

All symptoms of PD can worsen with stress. Lifestyle behaviors that can help reduce stress and improve PD symptoms include:

• Participating in a social exercise program—for example, dancing, tai chi, or yoga

• Finding ways to relax, like mindfulness or massage therapy

• Engaging in music therapy, perhaps in combination with physical activity

Can Levodopa Worsen Parkinson’s Disease?

Some people with PD wonder if Parkinson's disease medications, namely levodopa, make their disease progress faster.

What Is Levodopa?

Levodopa, or L-dopa, is the hallmark medication for Parkinson's disease. It increases dopamine levels in the brain and is the most effective drug for reducing PD symptoms.

After long-term use of levodopa, people may notice what are called OFF periods where their symptoms return, as the levodopa wears off sooner than expected.

Despite OFF periods and other complications of long-term levodopa use, like dyskinesia (excessive movements), no research suggests levodopa accelerates Parkinson's disease.

Unfortunately, there is also no research yet suggesting levodopa slows down the disease. Regardless, levodopa remains a vital therapy for controlling PD symptoms, although it needs to be thoughtfully used and dosed by an experienced provider throughout the disease course.

Learn More: Parkinson’s Disease Treatment

Situations and Activities to Avoid

Under the guidance of a Parkinson's disease specialist, limiting or avoiding certain foods, supplements, or scenarios may be advised.

Diet

While adequate water intake and a well-balanced diet like the Mediterranean diet benefit people with PD, experts don't know if there are any foods or drinks that are necessarily "bad" for Parkinson's.

That said, early research found the following foods to be associated with more rapid progression of Parkinson's:

• Canned fruits and vegetables

• Soda (both diet and nondiet)

• Fried foods

• Red meat

• Dairy products (e.g., ice cream, yogurt, cheese)

As such, limiting your intake of processed foods, added sugars, and saturated fats is a sensible strategy.

Instead, choose alternative food options. For example, for protein sources, you could eat beans and nuts. Likewise, try leafy green vegetables and tofu instead of dairy products for calcium.

Lastly, depending on the medications you are taking for Parkinson's, dietary changes may help avoid side effects or make the drugs work better.

For example, if you are taking an MAO-B inhibitor, such as Xadago (safinamide) or Eldepryl (selegiline), you must moderate your intake of foods rich in tyramine (e.g., aged cheese and cured meats).

MAO-B inhibitors also increase tyramine in the body and can elevate blood pressure when combined with tyramine-rich foods.

Supplements

Several supplements are being evaluated for treating Parkinson's disease, mainly creatine, coenzyme Q10 (CoQ10), inosine, and vitamin E.

Unfortunately, the research on their benefit so far is lacking. Therefore, it's prudent to avoid them unless your provider suggests otherwise.

Glutathione is another supplement that, unlike the ones mentioned above, is showing some promise for treating PD, although studies are still in the early stages.

Precaution

Always speak with your provider before taking any new medication or supplement to avoid harmful interactions or worsening symptoms.

Social Isolation

Due to the physical and mental challenges of living with Parkinson's disease, some people may withdraw from social activities and stop interacting with others, especially as the disease progresses.

Social isolation can negatively impact PD symptoms by contributing to loneliness and depression, limiting physical activity, and increasing stress.

Strategies to avoid social isolation include:

• Joining a support group, either virtual or in-person.

• Scheduling a weekly meal out with family members, neighbors, or members of a social/religious organization.
  

• Hiring a nurse or caretaker (if you haven't already) to help you with daily activities, with the added benefit of social interaction.

Pacing Yourself With Progressive Parkinson’s Disease

It's normal to experience feelings of powerlessness living with an incurable and progressive disease like Parkinson's disease.

Focus your energy on the parts of the condition you can control—drinking water, eating a well-balanced diet, getting regular physical activity, and reducing stress as best as possible.

Also, to keep symptoms at bay, take your medications as prescribed and see your healthcare provider for regular checkups.

Lastly, as you navigate the ebbs and flows of this unpredictable disease, don't hesitate to reach out to your healthcare team and loved ones for support and connection.

Summary

Parkinson's disease is progressive, so symptoms (e.g., slow movements, shaking, and stiffness) naturally worsen with time. Several environmental factors, namely physical inactivity, dehydration, poor diet, and stress, can aggravate symptoms and, perhaps, worsen disease progression.

The good news is that proactive steps can be taken to try to reverse these environmental factors—for example, by regularly exercising, eating a diet rich in anti-inflammatory foods, and reducing stress. Reaching out to others for support and avoiding social isolation are also essential to optimizing your PD care.

Read the original article on Verywell Health.