Paula,
I just think that all these symptoms have been there to be seen traditionally in PD, with the exception of those that are clearly side-effects and not symptoms.

So to talk about them as though they were not always there and visible is to re-write history. For instance it is not for nothing that once PD was treated in elderly patients who had it for a long time as a psychiatric disorder. In other words, there were always non motor symptoms, before levodopa, but neuros did not know what to do with them so they were passed on to the other variety of 'head' doctors, the psychiatrists, just as now if we manifest with bladder symptoms we are passed on to a urologist.

So to state that these symptoms only came into evidence in the 'dopamine era' is bending the truth.

So now patients are demanding, as they are more able and better informed, that these same symptoms be taken into consideration, and perhaps these same doctors who have always erred on the side ignoring these same symptoms can see that perhaps they can be treated....... but they have not yet really got a handle on dopamine treatments yet, We are better at this than they are. Look at the patients who have managed many years on dopamine, keeping their doses very low and ensuring that their brains have an even dose, or as much as possible, and have fewer side effects. But also consider those whose neuros do not really understand dopamine, and who willy-nilly encourage patients to up their dosage, or add other drugs, create huge cocktails of medication, and no-one professional really understands these complex interactions. In fact in the very elderly, because their brains by that time are very fragile, often drugs are reduced to the very minimum or in other words, dopamine only. Because the rest is too much for their bodies to cope with.

Obviously the best informed doctors are better, but we have seen many people come on the forums under-medicated, overmedicated, under-informed about their medication, and not knowing whether they were suffering from PD or side-effects, or whether they were progressing rapidly, and in a state of acute anxiety.

So I say that dopamine as a treatment has not really been properly understood. So how can we be at a stage called 'post-dopamine' era ? And if that is where we are heading, along with the industry that has accumulated around our condition, where are we going?? That is what I am asking about.

I do not know the answers, but I do think that when we are on a minimum of medication, and our non motor issues have been addressed, then we are likely to have the best quality of life.

It is making that happen, and making it work for us that is the real question. And I do believe that some of these things can happen without drug interventions, too. The multi-faceted approaches we have discussed here are surely part of the answer......