A diagnosis of young-onset Parkinson’s disease brings with it special challenges. For example, deciding how and when to disclose the diagnosis at work and to children can be difficult, not to mention coping with a progressive condition and trying to plan for the future. Social worker Elaine Book discusses these challenges and more, as well as techniques for dealing with them.

Driving is a complex task involving many physical skills and mental processes. Age, along with a chronic or progressive illness like Parkinson’s, affects these critical driving skills, making a driver less safe on the road. But giving up the keys is an emotionally charged issue. Lissa Kapust created DriveWise, a program that involves a multidisciplinary team of health professionals who do objective assessments of the many skills and mental abilities needed for safe driving.

There are many drugs and therapies for Parkinson’s, but none halt progression of the disease. This is partly because we still do not understand exactly what causes Parkinson’s, so it is hard to figure out how to prevent it or slow it down. One potential target for new therapies is alpha-synuclein, a protein found in the human brain that is associated with the development of PD. Scientists are looking at ways to clear abnormal forms of alpha-synuclein from the brain using various immune therapies. Dr. Mark Guttman discusses these approaches based on what is known and unknown about Parkinson’s today.

For decades, most people with Parkinson’s disease have been able to control symptoms with levodopa and other drugs. But researchers have yet to find a way to protect neurons in the brain to slow down or stop progression of Parkinson’s. Dr. David K. Simon discusses how modern genetics can be a guide to developing new drugs that might preserve nerve cells and – ultimately – keep Parkinson’s from progressing.

More than 50 years after its discovery, levodopa is still the most effective treatment for Parkinson’s, but some people experience “off” periods or dyskinesias with oral medications. Dr. Mark Guttman describes new delivery methods that promise to help with some of these problems, especially for people who have had Parkinson’s for many years. For example, levodopa infusions directly into the gut are currently available, and skin patches and special pills that stay in the stomach and release drug over a period of time are in development.

Parkinson’s can be unpredictable – symptoms can come and go or get better and worse throughout the day. These so-called “on-off” fluctuations (also called motor fluctuations) and dyskinesias can be troubling, but movement disorder specialists can help with the choice of medication, dosages, and timing. Dr. Irene Malaty explains more about what causes these changes and how you can work with your doctor to manage them.

Nutrition is increasingly part of the conversation when it comes to good Parkinson's care. Dr. Bas Bloem describes how diet can help improve some of the symptoms of Parkinson's and optimize the effects of medication, and he offers tips on getting adequate nutrition.

Regular exercise is essential for people with Parkinson's. Dr. Bas Bloem describes what is known about exercise and PD and what is still in the research stages, and he offers some tips on overcoming barriers to getting enough exercise.

Dr. Peter Schmidt of the Parkinson’s Foundation explains where people with Parkinson’s can go to receive the best interdisciplinary care and how the Foundation is improving standards of Parkinson’s care around the world. The Foundation's Centers of Excellence network and the Parkinson's Outcomes Project – the largest-ever clinical study of Parkinson’s – are key aspects of the discussion.

In this debut episode of Substantial Matters: Life and Science of Parkinson's, Dr. Michael Okun talks about early warning signs of Parkinson's and offers practical advice on how to proceed after a diagnosis.