Parkinson's with Autonomic Dysfunction - confusion

Hi all. My husband was diagnosed with PD around 18 months’ ago, and with Autonomic Dysfunction shortly after. He doesn’t have too many problems with movement at the moment, but has become extremely fatigued most of the time and increasingly confused. What’s difficult to judge is whether this is down to the condition, or to two new drugs that were recently added to his daily doses of Co-Careldopa. So, in addition he is now also taking a daily dose of 1.05mg of Pramipexole (slow-release given last thing at night to help with the fact he was slow in the mornings) and 60mg of Duloxetine (given to relieve mild anxiety). He’s less anxious, but if anything is even more sluggish in the mornings (and throughout the day). Does anyone have any experience of these drugs, and/or the combination of PD and Autonomic Dysfunction? Thanks.

Hello Oodles441 I saw no one has answered as of yet. All the people in this club are different. I can tell you that the antagonist drugs do have more side effects for others that post. My cousin takes Pramipexole and he seems more hyper and tends to be compulsive. My doctor has kept me on plan old sinemet.
My autonomic dysfunction was Constipation and hypostatic blood pressure with bouts of depression and through in fatigue. This I had before any diagnosis.

I am no doctor. But I am sluggish in the morning as well. Does your husband sleep straight through till morning or does he get up throughout the night. I saw you did not mention clonazePam it is usually given for Rem Sleep disorder. (that makes you foggy in the morning.) I think Most drugs for anxiety calm you down. (Fatigue?)do to drug. I know Co-Careldopa(sinemet) makes one tired. I take 900mg/day. (diagnosed 5 years symptoms 10years)
I definately would talk to you doctor about the confusion. I will tell you in my case if I have had times where my sleep has been little or none I have bouts of confusion.
It is always wise when talking to some of us PWP (I know someone who is hardheaded and difficult for his wife to get him to go to the doctor)?LOL
But it was helpful for me to have my cognition tested. Mine tested slowed but no start of dementia. Please this is not meant to scare you. (just clears up the confusion part of your post.) To end up your husband is lucky to have a wife like you who cares about him as you do. If he is a little hardheaded. I would let him read the post from a fellow hardhead. Going to the doctor and getting extra testes if needed are part of Parkinson’s. We are not a lesser man to admit things are changing. Going to the doctor many times restores some of the changes medicine might be causing. Everyone functions better family wise checking things out. Good day to you. Tom

I’ve been on duloxatine for 10 plus years (120mg per day) and have been on sinemet (6 x 62.5) for 2 years, duloxatine doesn’t tire me out personally, was on prozac b4 that but moved to duloxatine when that stopped working. I also take cbd but mainly find it helps my mood and cope with parkinsons better.


I have no idea re meds, but dehydration definitely makes my dad more sluggish and we have found that if he has black coffee, he is so much more able to have a good day (without, can barely lift his head off the bed, with can get up, move around, walk and helps his speech a bit too). It seems to make his meds much more effective. Won’t work for everyone, but worth a try (if able to drink, make sure he has plenty water too, I found my dad never realises when he is dehydrated until too late).

Good luck

Thanks so much for responding. I’m definitely going to make an appointment with the GP tomorrow and give his PD Nurse a call. Unfortunately he’s not due to see the consultant until July but in view of his Autonomic Dysfunction test results (not good) I’m going to see if I can get the appointment brought forward and to ask for cognitive testing. In answer to your question he only takes the drugs I mentioned. Sleep during the night isn’t too bad (interrupted mainly by visits to the loo) but he does dream a lot and can sometimes be woken as a result. It’s the confusion and overwhelming fatigue that are the main worries at the moment so I’ll try to get to the bottom of that problem first, I think. Cheers

Thanks for that. So difficult to judge re drugs, isn’t it, because I guess they affect people in different ways. Glad the Duloxetine seems to be working for you at any rate. Cheers.

It’s a vicious cycle isn’t it. I’m bored of my own voice nagging my husband to drink more. I genuinely think that, because of his confusion, he forgets. He’s generally cut coffee and alcohol fro m his diet but I’ll definitely give black coffee a go, and resume nagging mode re the water. Thanks.

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Many times the person looking after us PWP struggles in ways that we take for granted! Without that special person who make many sacrifices to make are lives better. Where would we be?
Oodles and to others like you. THANK YOU! PWP


Dehydration is definitely a danger. Like you say, you often find that they forget then as they get dehydrated they actually feel less thirsty. (Confusion can also be a sign of dehydration)
I stopped nagging as my dad got stubborn, I just used to make a drink, put it near then have a conversation while drinking (he chatted and would drink as a reaction to my drinking. Now I just syringe it down the tube when I see the signs.)

I really hope that the coffee works for your husband and will look out for any updates. Good luck.

Thanks FF. You’re right. They do forget. All I keep finding are cups of water. My husband fills them then forgets he’s done it so fills another, probably convincing himself that he drank the previous one. But I’\lll persevere!

Exactly and dehydration really adversely affects everyone not just those with PD so it’s great if able to help keep track. Take care, I will look forward to hearing how you are getting on