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

Authors: Goltz, Franziska | van der Heide, Anouk | Helmich, Rick C.

Article Type: Review Article

Abstract: Psychological stress, a state of mental strain caused by mentally or physically threatening situations, plays a significant role in Parkinson’s disease (PD). Motor symptoms worsen during acute stress and common non-motor symptoms in PD, such as anxiety and depression, are linked to chronic stress. Although evidence in humans is lacking, animal models of PD suggest that chronic stress can accelerate dopaminergic cell death. This suggests that stress-reducing interventions have not only symptomatic, but perhaps also disease-modifying effects. Our objective was to identify the most promising strategies for stress-reduction in PD and to analyze their potential value for disease-modification. An unstructured …literature search was performed, primarily focusing on papers published between 2020–2023. Several large clinical trials have tested the efficacy of aerobic exercise and mindfulness-based interventions on PD symptoms. The evidence is promising, but not definitive yet: some exercise trials found a reduction in stress-related symptoms, whereas others did not or did not report it. In the majority of trials, biological measures of stress and of disease progression are missing. Furthermore, follow-up periods were generally too short to measure disease-modifying effects. Hence, mechanisms underlying the intervention effects remain largely unclear. These effects may consist of attenuating progressive neurodegeneration (measured with MRI-markers of substantia nigra integrity or cortical thickness), or a strengthening of compensatory cerebral mechanisms (measured with functional neuroimaging), or both. Lifestyle interventions are effective for alleviating stress-related symptoms in PD. They hold potential for exerting disease-modifying effects, but new evidence in humans is necessary to fulfill that promise. Show more

Keywords: Psychological stress, Parkinson’s disease, disease progression, treatment, anxiety, depression

DOI: 10.3233/JPD-230211

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S147-S158, 2024

Authors: Gros, Priti | Spee, Blanca T.M. | Bloem, Bastiaan R. | Kalia, Lorraine V.

Article Type: Review Article

Abstract: Parkinson’s disease (PD) is a chronic and complex neurodegenerative disorder. Conventional pharmacological or surgical therapies alone are often insufficient at adequately alleviating disability. Moreover, there is an increasing shift toward person-centered care, emphasizing the concept of “living well”. In this context, arts-based interventions offer great promise, functioning as platforms for creative expression that could provide novel mechanisms to promote quality of life. Here we present a qualitative review of arts-based interventions for PD, including music, dance, drama, visual arts, and creative writing. For each, we discuss their applications to PD, proposed mechanisms, evidence from prior studies, and upcoming research. We …also provide examples of community-based projects. Studies to date have had relatively small sample sizes, but their findings suggest that arts-based interventions have the potential to reduce motor and non-motor symptoms. They may also empower people with PD and thereby address issues of self-esteem, foster personal problem-solving, and augment holistic well-being. However, there is a paucity of research determining optimal dosage and symptom-specific benefits of these therapies. If art were a drug, we would have to perform appropriately powered studies to provide these data before incorporating it into routine patient care. We therefore call for further research with properly designed studies to offer more rigorous and evidence-based support for what we intuitively think is a highly promising approach to support individuals living with PD. Given the possible positive impact on people’s lives, arts-based approaches merit further development and, if proven to be effective, systematic inclusion within integrated management plans. Show more

Keywords: Parkinson disease, art, dance, music, humanities, patient-centered care, randomized controlled trials as topic

DOI: 10.3233/JPD-240031

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S159-S172, 2024

Authors: Mathur, Soania | Mathur, Sarika

Article Type: Review Article

Abstract: Parkinson’s disease (PD) poses a number of challenges for individuals, affecting them physically, mentally, emotionally, and socially. The complex nature of PD necessitates empowering patients to address their unique needs and challenges, fostering improved health outcomes and a better quality of life. Patient empowerment is a multifaceted concept crucial to enhancing healthcare outcomes, particularly in chronic conditions such as PD. However, defining patient empowerment presents challenges due to its varied interpretations across disciplines and individuals. Essential components include access to information, development of self-care skills, and fostering a supportive environment. Strategies for patient empowerment encompass health literacy, education, and shared …decision-making within a trusted healthcare provider-patient relationship. In PD, patient empowerment is crucial due to the disease’s phenotypic variability and subjective impact on quality of life. Patients must navigate individualized treatment plans and advocate for their needs, given the absence of objective markers of disease progression. Empowerment facilitates shared decision-making and enables patients to communicate their unique experiences and management goals effectively. This paper provides a comprehensive overview of the dimensions and strategies associated with patient empowerment, its definition and the facilitators that are necessary, emphasizing its critical importance and relevance in Parkinson’s management. At the end of this review is a personal perspective as one of the authors is a person with lived experience. Show more

Keywords: Parkinson’s disease, patient empowerment, patient education, patient-centered care

DOI: 10.3233/JPD-230235

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S173-S180, 2024

Authors: Esper, Christine D. | Valdovinos, Blanca Y. | Schneider, Ruth B.

Article Type: Review Article

Abstract: Digital health technologies are growing at a rapid pace and changing the healthcare landscape. Our current understanding of digital health literacy in Parkinson’s disease (PD) is limited. In this review, we discuss the potential challenges of low digital health literacy in PD with particular attention to telehealth, deep brain stimulation, wearable sensors, and smartphone applications. We also highlight inequities in access to digital health technologies. Future research is needed to better understand digital health literacy among individuals with PD and to develop effective solutions. We must invest resources to evaluate, understand, and enhance digital health literacy for individuals with PD.

Keywords: Digital health literacy, Parkinson’s disease, telehealth, deep brain stimulation, health disparities, technology, wearable sensors

DOI: 10.3233/JPD-230229

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S181-S189, 2024

Authors: Sturkenboom, Ingrid H.W.M. | Talebi, Amir H. | Maas, Bart R. | de Vries, Nienke M. | Darweesh, Sirwan K.L. | Kalf, Johanna G.

Article Type: Review Article

Abstract: People with Parkinson’s disease (PD) experience a range of progressive motor and non-motor symptoms, that negatively affect their daily functioning, social participation and quality of life. Allied health therapies have emerged as an effective treatment approach—complementary to pharmacological and neurosurgical treatments—which reduces the impact of PD in daily life. In this article, we propose criteria for what constitutes specialized allied health care for PD, and we review allied health research in PD in terms of meeting these criteria and its outcomes for monodisciplinary approaches as well as multi- or interdisciplinary allied health interventions. We focus on the three most studied …allied health disciplines in PD: physical therapy, occupational therapy and speech-language therapy. Overall, the available evidence underscores the importance and potential benefits of specialized allied health care for people with PD. Our proposed criteria and recommendations for future research might help in further delineating specialized allied health care. Show more

Keywords: Parkinson’s disease, allied health personnel, rehabilitation, patient care team, physical therapy specialty, speech therapy, occupational therapy, health-related quality of life, activities of daily living

DOI: 10.3233/JPD-230307

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S193-S207, 2024

Authors: Thomas, Sue | Edwards, Emma | Kobylecki, Christopher

Article Type: Review Article

Keywords: Parkinson’s disease, Parkinson’s nurse specialists, quality improvement, service development

DOI: 10.3233/JPD-230224

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S209-S217, 2024

Authors: Duncan, Ryan P. | Earhart, Gammon M.

Article Type: Review Article

Abstract: Remote delivery of allied health therapies has long been possible, but adoption has been limited in some disciplines until relatively recently. The COVID-19 pandemic drove dramatic increases in use of remote delivery within allied health. This review summarizes the latest evidence on remotely-delivered physical therapy, occupational therapy, and speech therapy and discusses associated challenges and opportunities.

Keywords: Allied health, telemedicine, Parkinson’s disease, physical therapy, occupational therapy, speech therapy

DOI: 10.3233/JPD-230214

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S219-S226, 2024

Authors: Cilia, Roberto | Dekker, Marieke C.J. | Cubo, Esther | Agoriwo, Mary W.

Article Type: Review Article

Abstract: Allied health therapies refer to a range of healthcare professionals, including physiotherapists, occupational and speech-language therapists, who aim to optimize daily function and quality of life in conjunction with medical care. In this narrative review of literature on allied health therapies in people with Parkinson’s disease (PD), we focused on the diversity in healthcare access, state of the art, current challenges in the African continent, and proposed solutions and future perspectives. Despite the increasing prevalence and awareness of PD in Africa, numerous challenges persist in its management. These include resource limitations, geographical barriers, sociocultural beliefs, and economic constraints. Nevertheless, innovative …solutions, including telerehabilitation and community-based rehabilitation, offer hope. Collaborative efforts within the continent and internationally have shown potential in bridging training and resource gaps. Significant strides can be made with tailored interventions, technological advancements, and multifaceted collaborations. This review offers practical insights for healthcare professionals, policymakers, and caregivers to navigate and optimize PD care in the African context. Show more

Keywords: Parkinson’s disease, Africa, allied health therapies, rehabilitation, telemedicine

DOI: 10.3233/JPD-230262

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S227-S239, 2024

Authors: Hartmann-Nardin, Daniel | Stock, Stephanie | Kalbe, Elke | Folkerts, Ann-Kristin

Article Type: Systematic Review

Abstract: Background: Interest in non-pharmacological/non-surgical interventions to treat Parkinson’s disease (PD) has substantially increased. Although a few health-economic studies have been conducted, summary information on the cost-effectiveness is still scarce. Objective: To give an overview of cost-effectiveness analyses (CEA) focusing on non-pharmacological/non-surgical interventions in PD patients. Methods: A systematic literature search was conducted in five databases. Studies were included that provided cost-effectiveness analysis (CEA) or cost-utility analysis (CUA) of non-pharmacological/non-surgical interventions in PD patients. Study quality was assessed with the Drummond and CHEERS 2022 checklists, respectively for economic evaluation. Results: N  = 9 …studies published between 2012–2023 were identified. Most studies undertook a CUA (n  = 5); n  = 3 reported a combination of CEA and CUA, and n  = 1 a pure CEA. Most studies (n  = 6) examined physical exercise. The CEA studies identified additional costs of 170€ –660€  for the improvement of one single unit of a clinical outcome and savings of 18.40€ –22.80€  per score gained as measured with established instruments. The four studies that found significant quality of life benefits show large variations in the incremental cost effectiveness ratio (ICER) of 3,220€ –214,226€  per quality-adjusted life year (QALY); notably interventions were heterogenous regarding content and intensity. Conclusions: Despite increasing numbers of non-pharmacological/non-surgical intervention trials in PD patients, health-economic evaluations are rare. The examined intervention types and health-economic results vary greatly. Together with the heterogeneity of the health-economic studies these factors limit the conclusions that can be drawn. Further research and a standardization of methods is needed to allow decision makers to make meaningful interpretations, and to allocate scarce resources. Show more

Keywords: Parkinson’s disease, intervention, rehabilitation, economics, cost-effectiveness

DOI: 10.3233/JPD-230213

Citation: Journal of Parkinson's Disease, vol. 14, no. s1, pp. S241-S252, 2024