[Akash]

Hi all, my father who is 80+ years old based out of India,was diagnosed with PD some 5 years back.

He was doing ok on Pacitane (https://en.wikipedia.org/wiki/Trihexyphenidyl) but suffered some amount of memory loss and cognitive impairment which was improved by B vitamin injections. However, a PD specialist had him shift to Syndopa (Synthetic Dopamine) after Carbidopa/Levidopa were tried first as I recall - as he felt it was a better treatment. None of these worked. Literally within months my fathers condition worsened. He developed dyskinesia, started having an inability to move, began shuffling.

However, for lack of a better alternative he stuck to Syndopa and now his symptoms have worsened significantly, while on Pacitane he was able to move around and had very little tremors, dystonia, drooling, on Syndopa the PD has progressed significantly with all the latter making his Quality of life miserable. Due to advanced age, DBS is not possible.

We recently went to another doctor whose conclusion is my father has some sort of Parkinson's Plus issue going on. Not Parkinsons alone as it would have been helped by Syndopa and analogs.

My question is are there any valid treatment methodologies for Parkinsons Plus or any possible things that could be affecting somebody apart from Parkinsons which are adjuncts to the overall issue. My father did have a love for a good drink, rich, sweet food and many years back he had to have his gallblader removed for the same. He was ok thereafter and he was however very physically active, going on long brisk walks & physically quite strong, self sufficient, mentally alert (post his engineering job and retirement, he remained very active and used to drive long distances too). Just adding this as a possible useful point regarding activities of daily living etc. His brain MRIs came out "normal" in that they merely show age related vascular changes but nothing particularly striking.

I was wondering whether it is common for a drug shift to cause such issues (Pacitane to Syndopa) and whether that provides a clue. Or it was merely progression and whether his severe movement issues (inability to take steps/stopping/motor control issues; drooling; drooped eye palsy on one side) are in fact Parkinsonian alone or are they a side effect of the Dopamine.

Can any B-Vitamin supplementation help?

He is mentally very alert and sharp. Its his motor control which is a severe issue for him, apart from his drooling which we have been recommended Botox for. However, his motor control issues have had no ideas suggested.

Any ideas, tips would be very welcome.