Brian,

What I find for myself is that I wake up feeling good, with little tremor. If I don't take any pills, I gradually decline over the next few hours. When I get around to taking my first drugs of the day, I tend to get worse to begin with, with tremor peaking. After a while, as levodopa levels have risen, my tremor almost disappears. Then, as the dose wears off the tremor increases again.

What is the timing of your aunt taking her first pill and eating breakfast?

I am surprised that she is taking only two doses per day, with the larger one at night. The short half life of levodopa means that she has very low levels of levodopa for most of the day. Is she moving around during the day? If she is mobile during the day, in spite of such a long gap between doses, it suggests to me that she is still producing and storing dopamine.

How long is it that your aunt thinks she has had PD? It is more normal to present with the symptoms on one side of the body only. Then, as the disease progresses over the next few years the other side becomes affected as well. Does she have any other symptoms of PD such as slowness of movement, rigidity, loss of smell, constipation etc.?

I think she should see a neurologist.

John