-
Journal of Neurology Aug 2022Disabling gait symptoms, especially freezing of gait (FoG), represents a milestone in the progression of Parkinson's disease (PD). This systematic review and network... (Meta-Analysis)
Meta-Analysis Review
INTRODUCTION
Disabling gait symptoms, especially freezing of gait (FoG), represents a milestone in the progression of Parkinson's disease (PD). This systematic review and network meta-analysis assessed and ranked interventions according to their effectiveness in treating gait symptoms in people with PD across four different groups of gait measures.
METHODS
A systematic search was carried out across PubMed, EMBASE, PubMed Central (PMC), and Cochrane Central Library from January 2000 to April 2021. All interventions, or combinations, were included. The primary outcome was changes in objective gait measures, before and after intervention. Outcome measures in the included studies were stratified into four different types of gait outcome measures; dynamic gait, fitness, balance, and freezing of gait. For the statistical analysis, five direct head-to-head comparisons of interventions, as well as indirect comparisons were performed. Corresponding forest plots ranking the interventions were generated.
RESULTS
The search returned 6288 articles. From these, 148 articles could be included. Of the four different groups of measurement, three were consistent, meaning that there was agreement between direct and indirect evidence. The groups with consistent evidence were dynamic gait, fitness, and freezing of gait. For dynamic gait measures, treatments with the largest observed effect were Aquatic Therapy with dual task exercising (SMD 1.99 [- 1.00; 4.98]) and strength and balance training (SMD 1.95 [- 0.20; 4.11]). For measures of fitness, treatments with the largest observed effects were aquatic therapy (SMD 3.41 [2.11; 4.71] and high-frequency repetitive transcranial magnetic stimulation (SMD 2.51 [1.48; 3.55]). For FoG measures, none of the included interventions yielded significant results.
CONCLUSION
Some interventions can ameliorate gait impairment in people with PD. No recommendations on a superior intervention can be made. None of the studied interventions proved to be efficacious in the treatment of FoG. PROSPERO (registration ID CRD42021264076).
Topics: Gait; Gait Disorders, Neurologic; Humans; Network Meta-Analysis; Parkinson Disease; Randomized Controlled Trials as Topic
PubMed: 35378605
DOI: 10.1007/s00415-022-11091-1 -
Journal of Parkinson's Disease 2018Cognitive dysfunction is one of the most prevalent non-motor symptoms in Parkinson's disease (PD), often experienced as more debilitating for patients and caregivers...
BACKGROUND
Cognitive dysfunction is one of the most prevalent non-motor symptoms in Parkinson's disease (PD), often experienced as more debilitating for patients and caregivers than motor problems. Therefore, a deeper understanding of the course of cognitive decline and the identification of valid progression markers for Parkinson's disease dementia (PDD) is essential.
OBJECTIVE
This systematic review summarizes the current state of knowledge on cognitive decline over time by reporting effect sizes of cognitive changes in neuropsychological tests.
METHODS
1368 studies were identified by a PubMed database search and 25 studies by additionally scanning previous literature. After screening all records, including 69 full-text article reviews, 12 longitudinal studies on the progression of cognitive decline in PD met our criteria (e.g., sample size ≥50 patients).
RESULTS
Only a few studies monitored cognitive decline over a longer period (>4 years). Most studies focused on the evaluation of change in global cognitive state by use of the Mini-Mental State Examination, whereas the use of neuropsychological tests was highly heterogenic among studies. Only one study evaluated patients' cognitive performance in all specified domains (executive function, attention & working memory, memory, language, and visual-spatial function) allowing for diagnosis of cognitive impairment according to consensus guidelines. Medium to strong effect sizes could only be observed in studies with follow-up intervals of four years or longer.
CONCLUSIONS
The results emphasize the need for the assessment of larger PD cohorts over longer periods of follow-up with a comprehensive neuropsychological battery.
Topics: Attention; Cognition; Cognition Disorders; Disease Progression; Executive Function; Humans; Language; Memory, Short-Term; Neuropsychological Tests; Parkinson Disease
PubMed: 29914040
DOI: 10.3233/JPD-181306 -
Sensors (Basel, Switzerland) Feb 2020Rigidity is one of the cardinal symptoms of Parkinson´s disease (PD). Present in up 89% of cases, it is typically assessed with clinical scales. However, these...
Rigidity is one of the cardinal symptoms of Parkinson´s disease (PD). Present in up 89% of cases, it is typically assessed with clinical scales. However, these instruments show limitations due to their subjectivity and poor intra- and inter-rater reliability. To compile all of the objective quantitative methods used to assess rigidity in PD and to study their validity and reliability, a systematic review was conducted using the Web of Science, PubMed, and Scopus databases. Studies from January 1975 to June 2019 were included, all of which were written in English. The Strengthening the Reporting of observational studies in Epidemiology Statement (STROBE) checklist for observational studies was used to assess the methodological rigor of the included studies. Thirty-six studies were included. Rigidity was quantitatively assessed in three ways, using servomotors, inertial sensors, and biomechanical and neurophysiological study of muscles. All methods showed good validity and reliability, good correlation with clinical scales, and were useful for detecting rigidity and studying its evolution. People with PD exhibit higher values in terms of objective muscle stiffness than healthy controls. Rigidity depends on the angular velocity and articular amplitude of the mobilization applied. There are objective, valid, and reliable methods that can be used to quantitatively assess rigidity in people with PD.
Topics: Electromyography; Humans; Joints; Movement; Muscle Rigidity; Muscles; Observational Studies as Topic; Parkinson Disease
PubMed: 32041374
DOI: 10.3390/s20030880 -
Neurological Sciences : Official... Feb 2023Several physical therapy modalities have been used to improve hand tremors in patients with Parkinson's disease (PD). However, little is known about the efficacy of... (Review)
Review
BACKGROUND
Several physical therapy modalities have been used to improve hand tremors in patients with Parkinson's disease (PD). However, little is known about the efficacy of these techniques. Therefore, we conducted this study to synthesize evidence from published studies on the efficacy of physical therapy techniques for hand tremors in PD patients.
METHODS
We followed the PRISMA statement and Cochrane handbook guidelines when conducting this study. We conducted an electronic literature search of PubMed, Cochrane Central Register of Clinical Trials, Web of Science, Ovid, and Embase, and then we selected clinical trials assessing the efficacy of any physical therapy intervention for hand tremors in patients with PD. Study outcomes were extracted, and evidence was synthesized narratively.
RESULTS
A total of six modalities described in six studies were included in this systematic review. Out of the six interventions, the tremor's glove and electrical stimulation showed significant improvements in root mean square angular velocity (59% and 43.8%, respectively) and UPDRS tremor score (P < 0.05 for both). Also, eccentric exercises were associated with significant reductions in the mean resting tremor amplitude (P < 0.05). These data were dependent on single studies; therefore, a meta-analysis was not feasible.
CONCLUSION
Several physical therapy interventions, such as electrical stimulation, exercises, transcranial low voltage pulsed electromagnetic fields, weights, and virtual reality showed promising results in reducing hand tremors. However, this evidence was based on a limited number of included studies, and more RCTs with larger sample sizes are required to confirm the efficacy of these interventions.
Topics: Humans; Parkinson Disease; Tremor; Physical Therapy Modalities; Exercise Therapy
PubMed: 36205810
DOI: 10.1007/s10072-022-06420-1 -
PloS One 2020Dance may help individuals living with Parkinson's disease (PD) improve motor and non-motor symptoms that impact quality of life (QOL). The primary aim of this... (Meta-Analysis)
Meta-Analysis
Dance may help individuals living with Parkinson's disease (PD) improve motor and non-motor symptoms that impact quality of life (QOL). The primary aim of this systematic review of randomized controlled trials (RCTs) was to evaluate the efficacy of dance in improving motor and non-motor symptoms of PD and QOL. The secondary aims of this review were to evaluate the methodological quality of included studies by assessing risk of bias across nine categories and to inform the direction of future research. Peer-reviewed RCTs that included people living with PD at all disease stages and ages and measured the effects of a dance intervention longer than one day were included. Sixteen RCTs involving 636 participants with mild to moderate PD were eligible for inclusion in the qualitative synthesis and nine in the meta-analysis. Overall, the reviewed evidence demonstrated that dance can improve motor impairments, specifically balance and motor symptom severity in individuals with mild to moderate PD, and that more research is needed to determine its effects on non-motor symptoms and QOL. RCTs that use a mixed-methods approach and include larger sample sizes will be beneficial in fully characterizing effects and in determining which program elements are most important in bringing about positive, clinically meaningful changes in people with PD.
Topics: Activities of Daily Living; Cognition; Dancing; Gait; Humans; Mental Health; Motor Disorders; Parkinson Disease; Postural Balance; Quality of Life
PubMed: 32756578
DOI: 10.1371/journal.pone.0236820 -
Journal of Parkinson's Disease 2020Signs of respiratory dysfunction can be present already early in the course of Parkinson's disease (PD). Respiratory training could alleviate this, but its effectiveness...
BACKGROUND
Signs of respiratory dysfunction can be present already early in the course of Parkinson's disease (PD). Respiratory training could alleviate this, but its effectiveness is not well understood.
OBJECTIVE
The purpose of this systematic review is to review the efficacy of different respiratory training interventions in PD.
METHODS
A search strategy was performed in four databases: PubMed, Physiotherapy Evidence Database (PEDro), Cochrane Library, and Cumulative Index to Nursing and Allied Health Literature (CINAHL). Methodological quality of original full-text articles was assessed using the Cochrane Risk of Bias tool for randomized controlled trials (RCTs) and the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool for the controlled trials (CTs). Levels of evidence were rated by the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach.
RESULTS
Six papers reporting on four randomized controlled trials and another four controlled trials were included. Positive effects were reported for inspiratory muscle strength training (IMST), expiratory muscle strength training (EMST), air stacking, breath-stacking, incentive spirometry and postural training on respiratory muscle strength, swallowing safety, phonatory aspects and chest wall volumes. Best methodological quality was found for breath-stacking and incentive spirometry. Best levels of evidence were found for EMST, IMST and EMST plus air stacking.
CONCLUSION
Respiratory training shows positive effects and should be considered when people with PD experience respiratory dysfunction. Future studies should focus on standardizing both training devices, instruments to measure outcomes and intervention protocols to further increase the level of evidence.
Topics: Breathing Exercises; Humans; Muscle Strength; Outcome Assessment, Health Care; Parkinson Disease; Respiration Disorders; Respiratory Muscles
PubMed: 32986684
DOI: 10.3233/JPD-202223 -
Clinical Rehabilitation Jul 2021To conduct a systematic review evaluating the effects of music-based movement therapy on motor function, balance, gait, mental health, and quality of life among... (Meta-Analysis)
Meta-Analysis
Effects of music-based movement therapy on motor function, balance, gait, mental health, and quality of life for patients with Parkinson's disease: A systematic review and meta-analysis.
OBJECTIVE
To conduct a systematic review evaluating the effects of music-based movement therapy on motor function, balance, gait, mental health, and quality of life among individuals with Parkinson's disease.
DATA SOURCES
A systematic search of PubMed, Embase, Cochrane Library, Web of Science, PsycINFO, CINAHL, and Physiotherapy Evidence Database was carried out to identify eligible papers published up to December 10, 2020.
REVIEW METHODS
Literature selection, data extraction, and methodological quality assessment were independently performed by two investigators. Publication bias was determined by funnel plot and Egger's regression test. "Trim and fill" analysis was performed to adjust any potential publication bias.
RESULTS
Seventeen studies involving 598 participants were included in this meta-analysis. Music-based movement therapy significantly improved motor function (Unified Parkinson's Disease Rating Scale motor subscale, MD = -5.44, = 0.002; Timed Up and Go Test, MD = -1.02, = 0.001), balance (Berg Balance Scale, MD = 2.02, < 0.001; Mini-Balance Evaluation Systems Test, MD = 2.95, = 0.001), freezing of gait (MD = -2.35, = 0.039), walking velocity (MD = 0.18, < 0.001), and mental health (SMD = -0.38, = 0.003). However, no significant effects were observed on gait cadence, stride length, and quality of life.
CONCLUSION
The findings of this study show that music-based movement therapy is an effective treatment approach for improving motor function, balance, freezing of gait, walking velocity, and mental health for patients with Parkinson's disease.
Topics: Exercise Test; Gait Disorders, Neurologic; Humans; Mental Health; Music Therapy; Parkinson Disease; Postural Balance; Quality of Life
PubMed: 33517767
DOI: 10.1177/0269215521990526 -
Journal of Neurology Jun 2022Freezing of gait (FOG) is one of the most disabling gait disorders affecting 80% of patients with Parkinson's disease (PD). Clinical guidelines recommend a behavioral... (Meta-Analysis)
Meta-Analysis
BACKGROUND
Freezing of gait (FOG) is one of the most disabling gait disorders affecting 80% of patients with Parkinson's disease (PD). Clinical guidelines recommend a behavioral approach for gait rehabilitation, but there is a wide diversity of behavioral modalities.
OBJECTIVE
The objective of this network meta-analysis was to compare the effectiveness of different behavioral interventions for FOG management in PD patients.
METHODS
Six databases were searched for randomized controlled trials of behavioral interventions for FOG management among PD patients from 1990 to December 2021. Bayesian network meta-analysis was used to combine both direct and indirect trial evidence on treatment effectiveness, while the surface under the cumulative ranking (SUCRA) score was used to estimate the ranked probability of intervention effectiveness.
RESULTS
Forty-six studies were included in the qualitative synthesis. Among, 36 studies (1454 patients) of 72 interventions or control conditions (12 classes) were included in the network meta-analysis, with a mean intervention period of 10.3 weeks. After adjusting for the moderating effect of baseline FOG severity, obstacle training [SMD -2.1; 95% credible interval (Crl): -3.3, -0.86], gait training with treadmill (SMD -1.2; 95% Crl: -2.0, -0.34), action observation training (SMD -1.0; 95% Crl: -1.9, -0.14), conventional physiotherapy (SMD -0.70; 95% Crl: -1.3, -0.12) and general exercise (SMD -0.64; 95% Crl: -1.2, -0.11) demonstrated significant improvement on immediate FOG severity compared to usual care. The SUCRA rankings suggest that obstacle training, gait training on treadmill and general exercises are most likely to reduce FOG severity.
CONCLUSION
Obstacle training, gait training on treadmill, general exercises, action observation training and conventional physiotherapy demonstrated immediate real-life benefits on FOG symptoms among patients with mild-moderate PD. With the promising findings, the sustained effects of high complexity motor training combined with attentional/cognitive strategy should be further explored. Future trials with rigorous research designs using both subjective and objective outcome measures, long-term follow-up and cost-effective analysis are warranted to establish effective behavioral strategies for FOG management.
Topics: Bayes Theorem; Gait; Gait Disorders, Neurologic; Humans; Network Meta-Analysis; Parkinson Disease
PubMed: 35244766
DOI: 10.1007/s00415-022-11031-z -
Parkinsonism & Related Disorders Jun 2017Parkinsonian-Pyramidal syndrome (PPS), defined as the combination of both pyramidal and parkinsonian signs is a concept that recently emerged. PPS may manifest itself in... (Review)
Review
INTRODUCTION
Parkinsonian-Pyramidal syndrome (PPS), defined as the combination of both pyramidal and parkinsonian signs is a concept that recently emerged. PPS may manifest itself in numerous neurodegenerative diseases, many of these being inherited. Their diagnosis is a major challenge for the clinical management, for the prognosis, for genetic counselling and, in a few cases, which should not be neglected, for specific treatment.
OBJECTIVE
Our objective is to provide a review of PPS and an algorithm in order to guide their diagnosis in clinical practice.
METHODS
We performed an exhaustive PubMed and OMIM research matching the following key words: "Parkinsonism and pyramidal signs" or "Parkinsonism and spasticity" or "pallido-pyramidal syndrome" or "Parkinsonism and spastic paraplegia". English publications from the last ten years were included.
RESULTS
We propose a pragmatic presentation based on several established classifications and we will distinguish inherited PPS found in complex hereditary spastic paraplegia, young onset parkinsonism, neurodegeneration with brain iron accumulation, primary familial brain calcifications, inborn errors of metabolism, and few rare others inherited neurodegenerative diseases, then non-inherited neurodegenerative PPS. We therefore suggest guidelines (based on age at onset, family history, associated clinical signs, brain MRI findings as well as certain laboratory investigations), for the diagnosis and the management of PPS. Many pathophysiological pathways may underlie PPS but the most frequent are those usually involved in both inherited Parkinson's disease and spastic paraplegia, i.e. mitochondrial pathway, vesicular trafficking including endosomal and lysosomal pathways as well as autophagy.
Topics: Blepharospasm; Brain; Databases, Bibliographic; Globus Pallidus; Humans; Magnetic Resonance Imaging; Parkinson Disease, Secondary; Parkinsonian Disorders
PubMed: 28256436
DOI: 10.1016/j.parkreldis.2017.02.025 -
Journal of Parkinson's Disease 2023Multiple observational studies have yielded controversial results regarding the association between Parkinson's disease (PD) and periodontitis. (Meta-Analysis)
Meta-Analysis
BACKGROUND
Multiple observational studies have yielded controversial results regarding the association between Parkinson's disease (PD) and periodontitis.
OBJECTIVE
This systematic review and meta-analysis was conducted to ascertain their bidirectional relationship.
METHODS
A literature search for relevant studies was performed in PubMed, EMBASE, the Cochrane Library, and Web of Science databases from inception to December 19, 2022. Effect sizes (ES) with 95% confidence intervals were pooled under the random-effects model. Then, leave-one-out sensitivity analysis and contour-enhanced funnel plot were applied to assess the stability of the results.
RESULTS
A total of 34 studies and 24 studies were included for systematic review and quantitative meta-analysis, respectively. Pooled ES indicated that periodontitis was not significantly associated with PD risk (HR = 1.13, 95% CI 0.88-1.45, n = 3; OR = 1.94, 95% CI 0.55-6.90, n = 7), while the Mendelian randomization study revealed no association between PD and periodontitis risk (coefficient [B] = -0.0001, standard error = 0.0001, p = 0.19). Furthermore, PD patients exhibited higher levels of periodontal pocket depth (SMD = 1.10, 95% CI 0.53-1.67), clinical attachment level (SMD = 1.40, 95% CI 0.55-2.26), plaque index (SMD = 0.81, 95% CI 0.22-1.39), and Oral Health Impact Profile-14 score (SMD = 0.91, 95% CI 0.33-1.49) compared to healthy controls.
CONCLUSIONS
Our meta-analysis identified no bidirectional association between PD risk and periodontitis risk, though the prevalence of periodontitis and poorer oral status was higher in PD patients.
Topics: Humans; Parkinson Disease; Periodontitis; Prevalence
PubMed: 37899063
DOI: 10.3233/JPD-230059