Ask an Expert: Mai-Ling Greschner Discusses how Nurse Practitioners can Support People with Parkinson’s
Mai-Ling Greschner is a Nurse Practitioner (NP) specializing in movement disorders. Over the past several years, she has worked closely with individuals living with Parkinson’s disease (PD) and related neurological conditions, providing expert assessment, treatment, and ongoing management. Her practice emphasizes evidence-based care, patient education, and optimizing quality of life for people affected by movement disorders. She is committed to advancing excellence in Parkinson’s care through clinical leadership, professional education, and advocacy for the expanding role of Nurse Practitioners within specialized neurological practice. She is also dedicated to promoting greater awareness of Parkinson’s disease and supporting initiatives that strengthen interdisciplinary, patient-centered models of care.
Can you please describe your role as a Nurse Practitioner in caring for people with Parkinson’s disease?
As a Nurse Practitioner specializing in movement disorders and Parkinson’s disease, I provide assessment, diagnosis, treatment, and ongoing management for individuals living with PD and related conditions. My role involves monitoring symptoms, optimizing treatment plans, addressing both motor and non-motor symptoms, and helping patients navigate changes that occur over time.
I also provide education and support to patients and their families and work closely with other healthcare professionals to ensure care is coordinated and responsive to individual needs. My overall goal is to help people maintain function, independence, and quality of life throughout their disease journey.
What led you to work with people living with Parkinson’s and movement disorders?
I have always been drawn to caring for people with complex, chronic conditions because the care is highly individualized and allows for meaningful, long-term relationships and the opportunity to support people over time as their symptoms and needs change. Even small improvements in mobility, confidence, or independence can have a significant impact on quality of life, and I find it very rewarding when I can help make that happen.
The field of movement disorders is continually evolving these days, with new research and treatment options emerging, which motivates me to keep expanding my knowledge and incorporating evidence-informed approaches into care.
How does your role differ from that of neurologists or other members of the healthcare team?
While there is considerable collaboration within the healthcare team, the unique contribution of my role as a Nurse Practitioner is often the ability to provide ongoing, patient-centered care with time to explore how Parkinson’s affects a person’s daily life. In addition to managing symptoms and treatments, I address concerns related to mood, cognition, sleep, caregiver wellbeing, function, and access to community resources.
I provide ongoing follow-up and serve as a consistent point of contact, helping coordinate care with neurologists and other healthcare professionals as needs develop. This continuity allows me to develop long-term relationships with individuals and families and support them through the different stages of the disease.
A unique aspect of my role within our clinic has been leading the implementation and ongoing management of continuous subcutaneous foslevodopa/foscarbidopa therapy. Introducing this advanced treatment required the development of clinical processes, patient education pathways, and monitoring strategies. For individuals with advanced Parkinson’s disease experiencing significant motor fluctuations, this therapy has been transformative, improving symptom control, independence, and quality of life. It has been especially rewarding to see patients who were previously struggling regain confidence and function through access to this innovative treatment option.
How can a person with PD see an NP for care? What are the benefits of seeing an NP, and when might other members of the healthcare team also be involved?
NPs are autonomous healthcare professionals who assess individuals, diagnose and manage health conditions, order and interpret diagnostic tests, prescribe medications, and provide comprehensive ongoing care. Many NPs work in primary care practice, serving as the most responsible healthcare provider for their patients, however some NPs practice in specialty healthcare settings such as neurology. NPs within specialty clinics retain their autonomous clinic functioning.
A person with PD may see an NP within a neurology or movement disorders clinic upon referral and admission to the clinic, often as part of a specialized Parkinson's care team. One of the benefits of seeing an NP is the opportunity for comprehensive, longitudinal care. Appointments often provide time to discuss symptoms, treatment goals, daily functioning, caregiver concerns, and quality of life. Many people living with PD value the continuity, accessibility, and ongoing support that NPs provide.
Depending on an individual's needs and presentation, other members of the healthcare team may become involved, including neurologists, physiotherapists, occupational therapists, speech-language pathologists, pharmacists, social workers, dietitians, and mental health professionals. Each member of the team lends their expertise to provide coordinated care that supports individuals and families throughout the course of PD.
What role do you play in medication management and monitoring side effects?
Medication management is a core component of my role as a neurology NP caring for individuals with Parkinson’s disease. Because symptoms and treatment needs evolve over time, ongoing assessment and medication optimization are essential. I independently evaluate treatment response, initiate and adjust medications, optimize dosing schedules, and work with individuals to achieve the best possible symptom control while minimizing side effects.
I also monitor and manage medication-related side effects and complications, including nausea, dizziness, orthostatic hypotension, hallucinations, confusion, excessive daytime sleepiness, dyskinesias, impulse control disorders, and wearing-off fluctuations. Through regular follow-up and comprehensive clinical assessment, I can often identify subtle changes early and make timely adjustments to improve safety, symptom control, and daily functioning.
Education is an important part of medication management. I advise individuals and their families on how medications work, the importance of timing and consistency, potential side effects, and when to seek support. By providing this information, I help patients and carepartners feel more confident and engaged in managing treatment decisions, which supports safer medication use and better outcomes.
When appropriate, I also help individuals understand advanced treatment options, such as deep brain stimulation (DBS) and infusion-based therapies (levodopa-carbidopa intestinal gel and subcutaneous foslevodopa/foscarbidopa). My role is to provide education, guide discussions, and help determine whether these options align with an individual’s goals, symptoms, and overall care priorities.
How do you help individuals stay informed and involved in their own care? Are there any ways you specifically involve carepartners and family members?
Education and shared decision-making are central to helping people remain active participants in their PD care. Following a diagnosis, many individuals and families feel overwhelmed. Part of my role is to help them better understand the condition, treatment options, and strategies for managing symptoms so they can feel more confident and informed when making decisions about their care.
Appointments are structured to allow time for discussion, questions, and individualized education based on each person's symptoms, stage of disease, and goals. I believe that understanding the "why" behind symptoms and treatment recommendations is just as important as the treatment itself. Rather than simply making recommendations, I take the time to explain the underlying causes of symptoms and the rationale behind different management options, so individuals are informed regarding decisions about their care.
Family members and carepartners are, with the patient’s consent, included in discussions whenever possible. They often provide valuable insight into changes in symptoms, cognition, behaviour, and daily functioning, and their involvement helps ensure that care plans are practical, effective, and sustainable at home.
Additionally, I help connect individuals and families with local, provincial, and national resources, including rehabilitation services, counselling, caregiver supports, and Parkinson’s organizations. In an era where health information is readily available online, it can be difficult to distinguish evidence-based information from misinformation. Part of my role is helping patients and families navigate this landscape by directing them to trusted, current, and evidence-based resources.
Are there lifestyle changes (such as exercise, diet, or routines) you emphasize?
Lifestyle strategies are a fundamental part of PD management and are emphasized alongside medical treatment. Regular exercise is strongly recommended because it helps maintain mobility, balance, strength, flexibility, and overall function. Clinical evidence supports aerobic exercise in PD; however, recommendations are individualized and may include walking, resistance training, stretching, balance exercises, yoga, tai chi, or Parkinson’s-specific exercise programs such as boxing programs.
Establishing consistent daily routines can also be helpful, particularly with medication timing, meals, sleep, hydration, and activity. Structured routines may help address symptoms such as apathy by providing external cues and reducing barriers to initiating activities. Consistent routines can also support symptom management and make day-to-day activities more predictable.
Nutrition is another important focus, including maintaining hydration, a high fiber diet to help manage constipation, and addressing challenges such as reduced appetite or swallowing difficulties. I work with individuals to develop realistic and sustainable lifestyle strategies that align with their abilities and goals. When needed, I involve other members of the interdisciplinary team, such as physiotherapists, occupational therapists, and dietitians, to provide additional support and expertise.
What are the biggest gaps you see in Parkinson’s care today, and what barriers do you think people face in accessing the support they need?
One of the most significant gaps I see in Parkinson’s disease care is the challenge of accessing timely, coordinated, and comprehensive support. While movement disorder clinics provide an important foundation for diagnosis and medical management, many individuals and families are left to navigate a complex healthcare system involving multiple providers, services, and settings. Managing appointments, referrals, and changing needs can be overwhelming, particularly while also adapting to the physical, emotional, and functional challenges of living with Parkinson’s disease.
Many individuals and families experience uncertainty in the early stages of Parkinson’s disease and may not know where to find trusted information, resources, or community support. Barriers such as geography, wait times, caregiver availability, and financial limitations can further affect access, particularly for those living in rural or underserved communities.
There is a clear need for more integrated, team-based models of care that bring interdisciplinary services—such as physiotherapy, occupational therapy, speech-language pathology, social work, and mental health support—into closer coordination with neurology care. When care is better connected, communication between providers improves, duplication is reduced, and individuals with Parkinson’s and their carepartners are better supported in making informed decisions and managing the disease over time.
Therefore, strengthening integrated care pathways and improving access to coordinated interdisciplinary support represent important opportunities to make Parkinson’s care more accessible, consistent, and responsive to the needs of individuals and their carepartners throughout the disease journey.
How do you see the role of Nurse Practitioners evolving in Parkinson’s care?
The role of NPs in PD care continues to expand as healthcare systems work to improve access to specialized services and address the growing demand for movement disorder care. With limited specialist availability in many regions and increasing complexity of PD care, NPs are helping bridge gaps by providing timely assessment, follow-up, education, and support within interdisciplinary teams.
Beyond direct clinical care, NPs are well positioned to improve continuity and patient experience across the healthcare system. They help individuals and carepartners navigate services, facilitate communication between providers, and support more integrated, patient-centered models of care. Their broad scope of practice allows them to adapt to evolving needs while providing consistent, long-term support.
Looking ahead, I expect NPs will continue to play a larger role in specialized movement disorder clinics, community-based care, and initiatives aimed at improving care for rural and underserved populations.
What has been the most rewarding part of working with individuals with Parkinson’s?
The most rewarding part of working with individuals with Parkinson’s disease is seeing how individualized care can make a meaningful difference in daily life. Whether through medication adjustments, education, or interdisciplinary support, even small improvements—such as better mobility, improved sleep, reduced symptom fluctuations, or greater confidence in daily activities—can have a significant impact on patients and their families.
Another rewarding aspect is helping individuals and their carepartners build confidence in managing the challenges of Parkinson’s disease. As their understanding of the condition grows, many become better equipped to participate in decision-making, adapt to change, and maintain a sense of independence despite disease progression.
On a personal level, my patients have taught me a great deal about resilience, perseverance, and gratitude. Watching people work tirelessly to maintain abilities that many of us take for granted has given me a deeper appreciation for movement and everyday function. Their determination inspired me to challenge my own assumptions about what I was capable of. After not running for more than a decade, I gradually returned to the sport, completed my first half marathon, and have since registered for a full marathon. I have also made other lifestyle changes, such as choosing to cycle whenever possible.
Overall, the dedication and resilience of my patients continue to inspire me. They have shaped not only how I care for others but also how I approach my own health, goals, and daily life.
Is there anything else you would like to add?
Caring for people with Parkinson’s disease has reinforced the importance of treating the whole person, not just the disease. While medications and symptom management are important, meaningful care also involves understanding an individual’s goals, values, support systems, and priorities for quality of life. Every person’s experience with Parkinson’s is different, and effective care requires a personalized approach that evolves over time.
I am continually impressed by the resilience of the people and families I work with. Despite the challenges that come with Parkinson’s disease, many individuals find ways to adapt, remain engaged in meaningful activities, and maintain a strong sense of purpose. Being able to support them through that journey is both a privilege and one of the most rewarding aspects of my work.
I have also been impressed by the exceptional sense of community within the Parkinson’s world, among both patients and healthcare professionals. Numerous organizations, many of them volunteer-led, offer opportunities for individuals to access trusted resources, connect with supportive communities, and participate in Parkinson’s disease–specific exercise and physiotherapy programs. Through local, national, and international collaborations, I have had opportunities for mentorship, education, teaching, and clinical partnership with movement disorder specialists, advanced practice providers, researchers, and patient advocates. These relationships have broadened my perspective, strengthened my clinical practice, and reinforced the value of a supportive community in improving patient care.
The collective knowledge, generosity, and commitment within the Parkinson’s community continue to motivate me and serve as a reminder that caring for people with Parkinson’s disease extends far beyond the clinic walls.
This content was published in the Fall 2026 edition of our quarterly magazine, Viewpoints. The content was accurate as of this publication date.