Is It Working: Early Parkinson’s

Monitoring Clinical Markers

1. Motor Performance

  • Tremor: Frequency/intensity does not increase; steadier handwriting and utensil use.

  • Bradykinesia (slowness): Buttoning clothes, utensil use, and finger tapping remain stable.

  • Rigidity: Less morning stiffness; range of motion maintained.

  • Marker: Stable Unified Parkinson’s Disease Rating Scale (UPDRS) motor scores over 6 months.

2. Gait & Balance

  • Walking speed: Consistent pace on timed walks.

  • Stride length & symmetry: No progressive shortening or shuffling.

  • Balance: Stable ability to stand from chair, turn, or walk without new falls.

  • Marker: No falls or near-falls in a 3–6 month window.

3. Daily Living Abilities

  • Instrumental ADLs: Handling keys, money, tools remains steady.

  • Basic ADLs: Dressing, eating, hygiene remain independent.

  • Marker: No new assistance required over 3–6 months.

4. Speech & Communication

  • Voice volume: Stable, not progressively softer.

  • Articulation: No new slurring or loss of clarity.

  • Marker: Family/caregiver reports of unchanged intelligibility.

5. Mood & Neuropsychiatric Symptoms

  • Depression/anxiety: Lower baseline distress, fewer mood swings.

  • Apathy/flat affect: No worsening of engagement or motivation.

  • Marker: Mood scales (e.g., PHQ-9, GAD-7) stable or improving.

6. Sleep & Circadian Rhythm

  • Sleep continuity: Fewer nighttime awakenings, less acting out dreams (REM behavior disorder).

  • Daytime alertness: Reduced sleepiness; steadier energy.

  • Marker: Noticeable stabilization within 2–8 weeks.

7. Autonomic Function

  • Constipation: Regular bowel rhythm; no worsening.

  • Blood pressure: No new dizziness/faintness on standing.

  • Sweating/temperature regulation: Stable patterns.

  • Marker: No new ER visits for syncope or dehydration.

8. Cognitive & Executive Function

  • Attention/working memory: Stable on short tests (Digit Span, Trail Making).

  • Multitasking: Cooking, conversation, or walking while talking remain manageable.

  • Marker: No new caregiver concerns about forgetfulness or confusion.

9. Safety Markers

  • Falls: Zero incidents across 6 months.

  • Driving/navigation: No new accidents, disorientation, or “close calls.”

  • Medication adherence: Pillbox checks remain accurate.

  • Marker: No emergency events in a 6–12 month window.

10. General Health

  • Nutrition & weight: Appetite stable; no unintended >3% weight loss per quarter.

  • Hydration & energy: Consistent daily intake and stamina.

  • Physical activity: Daily walks or exercise minutes remain stable.

11. Optional Medical/Lab Biomarkers

  • Vitamin D, B12, homocysteine: Normalized if low.

  • Inflammation markers (CRP): Stable or reduced.

  • Imaging/neurological biomarkers (if available): No accelerated decline beyond expected baseline trajectory.

12. Caregiver Markers

  • Burden/stress: Stable or reduced on monthly check-ins.

  • Support hours: No sudden increase in respite care or supervision needs.

13. Long-Term Trajectory

  • Motor slope: Decline curve flatter than typical untreated progression.

  • Function: Assistance needs unchanged at 6–12 months.

  • Safety: No increase in hospitalizations for falls, dehydration, or aspiration pneumonia.

  • Healthcare utilization: Stable number of routine vs. urgent visits.

Timeline of Expected Change

  • Weeks (2–8): Better sleep continuity, less stiffness, calmer mood, steadier energy.

  • Months (3–6): Plateau in tremor/slowness, stable ADLs, no increase in falls or speech decline.

  • Years (6–12+ months): Slowed motor decline, preserved independence in daily living, fewer safety events.