Don't Wait: Rethinking Parkinson's Disease Care for Brain Health

The moment someone hears, “you have Parkinson’s disease,” everything changes. Time slows. Questions multiply. And whether you’re a doctor or a patient, one thing becomes clear: time is more important than ever.

In our combined experience with Parkinson’s disease (PD) — one of us is a neurologist and a care partner, the other is both a patient and a physician — we have witnessed how early action and a brain-health-first approach can dramatically help shift outcomes. Too often, care begins with a wait-and-see mindset. But in PD, waiting can mean missing windows of opportunity that affect function, independence, and quality of life.

We urge everyone involved in treating this disease — providers, payers, patients, and families — to help redefine what good Parkinson’s care looks like. Managing motor symptoms is essential. But true progress comes from addressing the broader picture: preserving brain health, optimizing time, and restoring a sense of control.^1,2

The Increasing Urgency of Parkinson’s Disease
Parkinson’s disease, a progressive disorder of the central nervous system, has become the fastest growing neurological disorder worldwide; just within the US, approximately 1 million patients have been diagnosed.^3,4 Some studies show that the prevalence of PD is nearly 50% higher than the current estimate, with approximately 90,000 new cases each year.⁵

PD affects the dopamine-producing neurons in the brain that control movement, resulting in the characteristic slowness of movement, stiffness, resting tremors, and impaired balance so often associated with the disease. 

A Holistic Approach To Slow Down the Progression of PD
A PD diagnosis often feels like a race against time. Our job is to help patients see something different: a path forward, not a dead end. Our very first step in treating patients with PD starts at that very moment, with reassurance. Because we know how important it is for them to see their possibilities, not just their peril. 

When a patient approaches PD care feeling that their condition is manageable–that they have a measure of control–they tend to do better. Their hope and optimism can help them prioritize healthy eating, good sleep habits, exercise, and other positive lifestyle behaviors that we know may help delay the onset of PD symptoms and preserve brain health.^1,6,7 “I have Parkinson’s, but Parkinson’s does not have me” is the mindset we encourage. 

The Challenges of Adherence When Symptoms Fluctuate
One of our goals with PD treatment is for patients to spend less time thinking about their disease, and more time enjoying the things that are important in their lives. We have seen this to be one of the best indicators of adherence. Levodopa and carbidopa treatments have become the gold standard for managing Parkinson’s symptoms in the absence of a cure, but the clock is still ticking. 

As PD progresses, the therapeutic window for levodopa narrows. This can lead to increases in motor complications with “Off” time when levodopa levels are too low. We know that for patients, losing time to “Off” periods or being unable to predict when those periods may happen can take a heavy toll on their quality of life. Maximizing consistent “On” time can be transformative. In fact, a real-world study found that in patients with advanced PD, hourly increases in “Good On” time (where symptoms are well-controlled without troublesome involuntary movements) were associated with better clinical outcomes, greater humanistic value, and reduced economic burden.⁸

Frequent, unpredictable “Off” times can be an intrusive reminder about PD. So is a heavy pill burden. Each dose puts PD back into the foreground, and if dosing affects meal timing, that complexity can add to the day-to-day challenges of living with PD. Factors like these are most likely why adherence to treatment drops as pill count rises. Our experience tells us that compliance starts to dip when patients have to take more than 4 doses a day; at that point, we start to see them enjoying life less and needing more care. 

Extended-release oral carbidopa-levodopa (CD/LD) formulations, like CREXONT® (carbidopa and levodopa) extended-release capsules, which is approved for the treatment of Parkinson’s disease, can provide patients with smoother symptom control and longer, more predictable stretches of “On” time.⁹ The RISE-PD head-to-head trial demonstrated that CREXONT provides more “Good On” time per day, and 1.6 more hours of “Good On” time per dose compared to immediate release CD/LD.⁹ This represents a 70% increase in the amount of time each dose helps people feel in control of their PD symptoms. The most common adverse reactions with CREXONT (incidence ≥3% and greater than IR CD/LD) are nausea and anxiety. See Important Safety Information below.

This is not a small difference. It’s hours of improved movement, moments of regained independence, and days that feel a little more like they used to before PD. With more predictable symptom control, fewer daily doses, and longer stretches of “Good On” time, patients can spend more time living – and less time thinking about their next dose.

However, all too often, innovative treatments that can give PD patients the increased “On” time they need are not as widely covered by insurance plans. 

We believe this must change.

Access to Treatments Can Change Patient Outcomes
Access to new medicines is essential to ensure ongoing innovation and the availability of treatment options so all PD patients can have the best outcomes. Just as we encourage our patients to see the possibilities and embrace the positive mindset that puts time on their side, we must make that same case to insurance providers and advocate for the consistent, optimal care that our patients need, which is often found through treatment advancements. 

Doing so, as neurologists, we can help ensure that the care we provide for people with PD is always moving forward.

This article was sponsored by Amneal Pharmaceuticals.