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I am a 54 yr old very healthy female diagnosed in Jan. 2017 with parkinsonism. My main symptoms are reduced fine motor in left hand (typing is hard), left arm swing, some stiffness in shoulders/neck, and left foot feels awkward (lags?) when walking on flat surfaces like a sidewalk. I have to really focus to keep my feet in rhythm. The faster I walk the easier it is. Running is almost easier. When I hike on hilly or mountain trails I am fine and symptom free. I also have very subtle slurring of certain words when tired or stressed. 

I am super active - bike to work 24 miles round trip, strenuous hiking on weekends, plus do 45 minutes 80-90 rpms on stationary bike 3x week. And the Boston College parkinsons stretching and strengthening program...some every day. 

How do I know when to start on medications? And what medications are best for what symptoms?

I want to stay active for a long time. 


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This is a complex question, but in general when you have symptoms affecting your quality of life and ability to function it is time to start.  There are many strategies and this is something that you should talk to your doc about.  MAO-B drugs and exercise are first line, but you likely need levodopa or agonist and this needs discussion and monitoring especially for the agonist.  Hope that helps.

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