A. Initial Treatment of Early Disease Since, as noted above, there is no medication to cure or slow down the disease process, a major question that faces patients and physicians is whento start treatment and with what drug in a patient newly-diagnosed with PD.Most PD experts agree that treatment should not be started until a patient isexperiencing some “functional disability” from the disease. They key concepthere is the definition of the word “functional” because functional disability maybe different for different people. In general, it means that the patient is havingd i fficulty or is unable to do something that is important to his well-being or hisinterests. For example, a surgeon with a little bit of difficulty manipulatingobjects with his dominant hand may be functionally disabled by this problem. Aretired accountant may not be functionally disabled by the very samesymptoms. Whether or not a patient is functionally disabled is a decision thatshould be made by both the patient and physician together and appropriatetreatment begun at that time. Functional disability, however, should not bemeasured only in relation to work. Hobbies and sports activities can be veryimportant to people and should enter into the consideration of whether or not apatient is functionally impaired. Many patients’ symptoms begin with tremor. A sa rule, resting tremor is rarely disabling for most patients. Patients should trynot to force the doctor to treat tremor early on just to avoid some perceivedembarrassment unless there is accompanying functional disability from thet r e m o r.

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