“ASK THE DOCTOR” WITH DR. REBECCA GILBERT
Q: My husband was diagnosed with Parkinson’s disease (PD) and mild cognitive impairment and his neurologist prescribed donepezil (brand name Aricept), but it says on the package insert that this medication is for Alzheimer’s disease. Should he be taking it?
A: While it is true that donepezil is approved for Alzheimer’s disease, it is sometimes used by neurologists off-label to treat cognitive issues of all types. (It is legal and fairly common for doctors to prescribe a medication off-label.) It is likely that his neurologist felt there was a strong enough chance that donepezil could help your husband and therefore prescribed it for him.
If you still have concerns or questions about him taking it, you should talk directly to his doctor. It is always wise to understand the medications you’re taking and why you are taking them.
Q: Is lower back pain a symptom of PD?
A: Lower back pain is extremely common in the general population, so it is hard to tease out whether it is even more common among people with PD. It probably is, since rigidity, or stiffness of the muscles — which is a common symptom among people with PD — can exacerbate pain.
As always, make sure any new or worsening symptom, including lower back pain, is evaluated by your physician to make sure that any serious medical condition is ruled out first. The focus can then turn to reducing pain and improving quality of life. There are multiple strategies to manage lower back pain in the context of PD. Exercise and physical therapy are usually the first lines of treatment to try and often can result in a noticeable improvement.
If the pain is exacerbated by the rigidity of PD, it could potentially fluctuate with medication timing and therefore may be able to be treated by adjusting the timing and dosage of medications, so be sure to talk with your doctor about this possibility.
Q: My wife has had PD for many years. She is currently not able to swallow her medications and often spits them out. What can we do?
A: The first step would be a swallow study performed by a speech pathologist to see what her swallowing function looks like. Since she may also be having trouble swallowing certain foods, a swallow study will help determine what consistencies of foods your wife can safely eat.
Also, you should be aware that depending on which medications she is supposed to take, her doctors can prescribe formulations that are easier to swallow or can be crushed. Regular carbidopa/levodopa (brand name Sinemet) can be crushed and mixed with food. Carbidopa/levodopa also comes in a formulation called Parcopa that dissolves under the tongue. The extended-release formulation Rytary is designed as different sized beads inside a capsule. The capsule can be opened, and the beads can be mixed with food such as apple sauce, and they retain their long-acting status.
Dr. Rebecca Gilbert is the Chief Mission Officer at APDA. She oversees APDA’s research portfolio in conjunction with APDA’s Scientific Advisory Board. She also provides medical and clinical expertise to support APDA programming as well as print and web content.