Journal of Parkinson's Disease - Volume 14, issue s1

Authors: Kalbe, E. | Bloem, B.R. | Kalia, L.V. | Nieuwboer, A.

Article Type: Editorial

DOI: 10.3233/JPD-249009

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S1-S4, 2024

Authors: Rafferty, Miriam R. | Foster, Erin R. | Roberts, Angela C. | Smaller, Kevin A. | Johnson, Lynn L. | Lawson, Rachael A.

Article Type: Review Article

Abstract: Motor and nonmotor symptoms occur in early Parkinson’s disease (PD), or even in the prodromal stage. Many of these symptoms can be addressed by allied health therapies, including physical therapy, occupational therapy, speech therapy, and psychological therapies. However, referrals to these services early in the disease are low. We provide a review summarizing the efficacy of proactive allied health interventions on motor and nonmotor symptoms and daily function in prodromal and early disease. We also highlight areas for additional research and provide recommendations to improve care for individuals with early PD within each discipline. We recognize the overlapping roles of …the allied health disciplines and support integrated or transdisciplinary care beginning soon after diagnosis to help stem the tide in the progression of PD symptoms and disability. Show more

Keywords: Allied health occupations, physical therapy, occupational therapy, speech therapy, applied psychology, interdisciplinary research, exercise, Parkinson’s disease

DOI: 10.3233/JPD-230267

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S7-S19, 2024

Authors: Tosefsky, Kira N. | Zhu, Julie | Wang, Yolanda N. | Lam, Joyce S.T. | Cammalleri, Amanda | Appel-Cresswell, Silke

Article Type: Review Article

Abstract: The aim of this review is to examine the intersection of Parkinson’s disease (PD) with nutrition, to identify best nutritional practices based on current evidence, and to identify gaps in the evidence and suggest future directions. Epidemiological work has linked various dietary patterns and food groups to changes in PD risk; however, fewer studies have evaluated the role of various diets, dietary components, and supplements in the management of established PD. There is substantial interest in exploring the role of diet-related interventions in both symptomatic management and potential disease modification. In this paper, we evaluate the utility of several dietary …patterns, including the Mediterranean (MeDi), Mediterranean-DASH Intervention for Neurodegenerative Delay (MIND), Alternative Healthy Eating Index (AHEI), vegan/vegetarian, and ketogenic diet in persons with PD. Additionally, we provide an overview of the evidence relating several individual food groups and nutritional supplements to PD risk, symptoms and progression. Show more

Keywords: Diet, nutrition therapy, Parkinson disease, neurodegenerative diseases, inflammation, malnutrition, Mediterranean diet, ketogenic diet, probiotics, dietary supplements, vitamins.

DOI: 10.3233/JPD-230264

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S21-S34, 2024

Authors: Li, John | Aulakh, Nimrit | Culum, Ivan | Roberts, Angela C.

Article Type: Review Article

Abstract: Background: Low adherence to non-pharmacological interventions can impact treatment effectiveness. Yet, there is limited information on adherence barriers and facilitators to non-pharmacological interventions in Parkinson’s disease (PD). Objective: 1) To examine the quality of adherence reporting and 2) to identify key determinants of adherence to PD non-pharmacological interventions. Methods: A rapid evidence assessment was conducted, following PRISMA guidelines, that included controlled studies of exercise, physiotherapy, occupational therapy, speech-language therapy with explicit reporting of ‘adherence’ OR ‘compliance’, published in the last 15 years. Data extracted included: adherence rates, adherence outcomes, and factors associated with adherence. A collaborative …thematic analysis was conducted to identify determinants of adherence. Results: The search yielded 2,445 articles of which 114 met criteria for full screening with 45 studies meeting all inclusion criteria. High quality adherence data that aligned with the intervention goals were reported by 22.22%(N  = 10) of studies, with the majority reporting attendance/attrition rates only 51.11%(N  = 23). Four major themes (34 subthemes) emerged: disease and health, personal, program design, and system and environmental. Conclusions: There has been limited progress in the quality of adherence reporting in PD non-pharmacological interventions over the last decade. Acknowledging this limitation, key determinants of adherence included: alignment with personal beliefs, attitudes, and expectations; the demands of the intervention and worsening disease symptoms and personal/time obligations; and accessibility and safety concerns. Program design elements found to facilitate adherence included: opportunities for social engagement and in-person offerings linked to higher levels of interventionist support, performative feedback, and social reinforcement. Show more

Keywords: Parkinson’s disease, non-pharmacological interventions, exercise, rehabilitation, speech-language therapy, physiotherapy, occupational therapy, adherence, compliance, clinical trial

DOI: 10.3233/JPD-230266

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S35-S52, 2024

Authors: Mezzarobba, Susanna | Bonassi, Gaia | Avanzino, Laura | Pelosin, Elisa

Article Type: Review Article

Abstract: Action observation (AO) and motor imagery (MI) has emerged as promising tool for physiotherapy intervention in Parkinson’s disease (PD). This narrative review summarizes why, how, and when applying AO and MI training in individual with PD. We report the neural underpinning of AO and MI and their effects on motor learning. We examine the characteristics and the current evidence regarding the effectiveness of physiotherapy interventions and we provide suggestions about their implementation with technologies. Neurophysiological data suggest a substantial correct activation of brain networks underlying AO and MI in people with PD, although the occurrence of compensatory mechanisms has been …documented. Regarding the efficacy of training, in general evidence indicates that both these techniques improve mobility and functional activities in PD. However, these findings should be interpreted with caution due to variety of the study designs, training characteristics, and the modalities in which AO and MI were applied. Finally, results on long-term effects are still uncertain. Several elements should be considered to optimize the use of AO and MI in clinical setting, such as the selection of the task, the imagery or the video perspectives, the modalities of training. However, a comprehensive individual assessment, including motor and cognitive abilities, is essential to select which between AO and MI suite the best to each PD patients. Much unrealized potential exists for the use AO and MI training to provide personalized intervention aimed at fostering motor learning in both the clinic and home setting. Show more

Keywords: Parkinson’s disease, action observation, motor imagery, physiotherapy, training, mirror neuron system

DOI: 10.3233/JPD-230219

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S53-S64, 2024

Authors: Allen, Natalie Elizabeth | Romaliiska, Oksana | Naisby, Jenni

Article Type: Review Article

Abstract: Pain is a distressing and universal experience, yet everyone’s pain experience is influenced by a complex array of biological, psychological, and social factors. For people with Parkinson’s disease (PwP), these biopsychosocial factors include neurodegeneration and the psychological and social factors that accompany living with a chronic, neurodegenerative condition in addition to the factors experienced by those in the general population (e.g., living with co-morbidities such as osteoarthritis). The way these factors influence each individual is likely to determine which pain management strategies are optimal for them. This review first describes pain and the biopsychosocial model of pain. It explores how …pain is classified in Parkinson’s disease (PD) and describes the three main types of pain: nociceptive, neuropathic, and nociplastic pain. This background provides context for a discussion of non-pharmacological pain management strategies that may aid in the management of pain in PwP; exercise, psychological strategies, acupuncture and massage. While there is little PD-specific research to inform the non-pharmacological management of pain, findings from current PD research are combined with that from chronic pain research to present recommendations for clinical practice. Recommendations include assessment that incorporates potential biopsychosocial contributors to pain that will then guide a holistic, multi-modal approach to management. As exercise provides overall benefits for PwP, those with chronic pain should be carefully monitored with exercise prescribed and adjusted accordingly. Research is needed to develop and evaluate multi-modal approaches to pain management that are delivered in a biopsychosocial framework. Show more

Keywords: Pain, Parkinson’s disease, biopsychosocial models, rehabilitation, multimodal treatment

DOI: 10.3233/JPD-230227

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S65-S80, 2024

Authors: Palma, Jose-Alberto | Thijs, Roland D.

Article Type: Review Article

Abstract: Symptoms of autonomic dysfunction are prevalent and can be very debilitating, reducing the quality of life in patients with Parkinson’s disease (PD) and other synucleinopathies such as dementia with Lewy bodies and multiple system atrophy. Non-pharmacological therapies are key to effective management and are frequently used alone in patients with mild autonomic symptoms, or in combination with pharmacological therapies in patients with moderate and severe symptoms. This article focuses on non-pharmacological approaches. Our objective was to review the non-drug and non-surgical approaches to treating autonomic symptoms in patients with PD and other synucleinopathies, focusing on cardiovascular, gastrointestinal, and genitourinary autonomic …dysfunction. Evidence supporting the effectiveness of non-pharmacological treatment for the management of neurogenic orthostatic hypotension, supine hypertension, constipation, and bladder and sexual dysfunction is available. High-quality prospective trials are scarce, yet some non-pharmacological interventions (e.g., physical counter maneuvers) can be evaluated relatively quickly on an individual basis and often seem effective. The emerging variety of clinical presentations advocates for a stepwise, individualized, and non-pharmacological approach for the management of autonomic symptoms. Often, the first step is to reduce or discontinue drugs that cause or aggravate autonomic symptoms followed by lifestyle measures. While non-pharmacological and non-surgical treatments are available and, in many cases, effective to improve symptoms of autonomic dysfunction in PD and other synucleinopathies, they are often overlooked. Large randomized trials testing and comparing non-pharmacological approaches are warranted. Show more

Keywords: Parkinson’s disease, orthostatic hypotension, constipation, urinary dysfunction, sexual dysfunction, non-motor symptoms, supine hypertension, dysautonomia

DOI: 10.3233/JPD-230173

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S81-S92, 2024

Authors: Steendam-Oldekamp, Elien | van Laar, Teus

Article Type: Systematic Review

Abstract: Background: Parkinson’s disease (PD) is a progressive disease, which is associated with the loss of activities of daily living independency. Several rehabilitation options have been studied during the last years, to improve mobility and independency. Objective: This systematic review will focus on inpatient multidisciplinary rehabilitation (MR) in people with Parkinson’s disease (PwPD), based on recent studies from 2020 onwards. Methods: Search strategy in three databases included: multidisciplinary rehabilitation, Parkinson’s Disease, inpatient rehabilitation, motor-, functional- and cognitive performance, cost-effectiveness, Quality of Life, and medication changes/Levodopa equivalent daily doses. Results: Twenty-two studies were included, consisting of …13 studies dealing with inpatient MR and 9 studies on inpatient non-MR interventions. Inpatient PD multidisciplinary rehabilitation proved to be effective, as well as non-MR rehabilitation. Conclusions: This review confirms the efficacy of inpatient MR and non-MR in PD, but is skeptical about the past and current study designs. New study designs, including new physical training methods, more attention to medication and costs, new biomarkers, artificial intelligence, and the use of wearables, will hopefully change rehabilitation trials in PwPD in the future. Show more

Keywords: Parkinson’s disease, multidisciplinary treatment, inpatient rehabilitation, drug optimization

DOI: 10.3233/JPD-230271

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S93-S112, 2024

Authors: Folkerts, Ann-Kristin | Ernst, Moritz | Gollan, Romina | Cryns, Nora | Monsef, Ina | Skoetz, Nicole | Kalbe, Elke

Article Type: Systematic Review

Abstract: Background: Physical exercise interventions are known to improve quality of life, motor and non-motor symptoms in people with Parkinson’s disease (PD). However, systematic reviews and meta-analyses on cognitive outcomes are rare. Objective: To perform a systematic review and meta-analysis of physical exercise intervention effects compared with passive and active control groups (CGs) on global cognition in people with PD. Methods: A literature search was performed for randomized controlled trials (RCTs) on physical exercise interventions in PD using nine databases. We included RCTs reporting global cognition outcomes. A meta-analysis was performed using random-effects models …and standardized mean differences (SMDs) with 95% confidence intervals (CIs). Bias was assessed with the revised Cochrane Risk of Bias tool and the certainty of evidence was rated using the GRADE approach. Results: Seventeen studies (ten with passive, seven with active CGs) were included in the systematic review. Exercise interventions varied considerably between studies. The meta-analysis included nine studies with 236 people with PD (seven with passive, two with active CGs). The SMD was 0.33 (95% CI 0.00; 0.65) demonstrating a small effect (p  = 0.05) in favor of physical exercise. Compared with passive CGs, physical exercise had a small non-significant effect (SMD = 0.22, 95% CI –0.14;0.58, p  = 0.24). Compared with active CGs, physical exercise had a medium significant effect (SMD = 0.72, 95% CI 0.12;1.33, p  = 0.02). Conclusions: Physical exercise may increase global cognition in people with PD, but the evidence is very uncertain. Further large-scale RCTs are needed to confirm this finding and to identify the most effective type of physical exercise for improving cognition. Show more

Keywords: Parkinson’s disease, physical exercise, neuropsychology, cognition, mental status and dementia tests

DOI: 10.3233/JPD-230343

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S115-S133, 2024

Authors: van Wegen, Erwin E.H. | van Balkom, Tim D. | Hirsch, Mark A. | Rutten, Sonja | van den Heuvel, Odile A.

Article Type: Review Article

Abstract: Non-pharmacological interventions, including cognitive-behavioral therapy (CBT), non-invasive brain stimulation (NIBS), electroconvulsive therapy (ECT), light therapy (LT), and physical rehabilitation/exercise, have shown promise as effective approaches to treat symptoms of depression and anxiety in individuals with Parkinson’s disease (PD). In this narrative literature overview, we discuss the state-of-the-art regarding these treatment options and address future perspectives for clinical practice and research. Non-pharmacological interventions hold promise to treat depression and anxiety in PD. There is meta-analytic evidence for the efficacy of CBT, NIBS, ECT, LT, and exercise on improving depressive symptoms. For the treatment of anxiety symptoms, CBT shows large effects but …scientific evidence of other non-pharmacological interventions is limited. Importantly, these treatments are safe interventions with no or mild side-effects. More research is needed to tailor treatment to the individuals’ needs and combined interventions may provide synergistic effects.We conclude that non-pharmacological interventions should be considered as alternative or augmentative treatments to pharmacological and neurosurgical approaches for the treatment of depression and anxiety in individuals with PD. Show more

Keywords: Non-pharmacological interventions, depression, anxiety, Parkinson, physical rehabilitation and exercise, non-invasive brain stimulation, light therapy, cognitive-behavioral therapy, electroconvulsive therapy

DOI: 10.3233/JPD-230228

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S135-S146, 2024