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Yi M, Zhang W, Zhao B, Wang Z. The Effects of Mindfulness-Based Interventions in People with Parkinson's Disease: A Systematic Review and Meta-Analysis. Clin Gerontol 2024:1-19. [PMID: 38324289 DOI: 10.1080/07317115.2024.2314192] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2024]
Abstract
OBJECTIVES To examine the effectiveness of mindfulness-based interventions (MBIs) on psychological symptoms, motor symptoms, and quality of life in patients with Parkinson's disease (PD). METHODS Published studies in Chinese and English languages, conducted from inception to March 2023, were identified by searching PubMed, Web of Science, Cochrane Library, CINAHL, PsycINFO, and two Chinese electronic databases. The systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta Analyses guidelines. RESULTS Twelve studies were selected for quantitative syntheses. The impact of MBIs on reducing depression and anxiety, and improving mindfulness and quality of life in PD patients was statistically significant compared to the control group. However, no statistically significant effect on motor symptoms was observed. Subgroup analysis indicated that participants from Asia, those who received face-to-face sessions, and those whose sessions lasted 1.5 hours showed a more positive effect than other subgroups. CONCLUSIONS Patients with PD may benefit from MBIs to improve psychological symptoms and quality of life. MBIs represent a pivotal non-pharmacological therapeutic approach in clinical practice. CLINICAL IMPLICATIONS MBIs confer positive improvements in psychological well-being and quality of life in PD patients. However, it remains challenging to conclusively determine their efficacy in addressing motor symptoms.
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Affiliation(s)
- Mo Yi
- School of Nursing, Peking University, Beijing, China
| | - Wenmin Zhang
- School of Nursing, Peking University, Beijing, China
| | - Baosheng Zhao
- Department of Emergency, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong, China
| | - Zhiwen Wang
- School of Nursing, Peking University, Beijing, China
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Atak I, Artan T. Effects of a mindfulness-based groupwork program on adolescents in a children's home. SOCIAL WORK IN HEALTH CARE 2024; 63:168-187. [PMID: 38217519 DOI: 10.1080/00981389.2024.2302631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/26/2022] [Accepted: 12/20/2023] [Indexed: 01/15/2024]
Abstract
Mindfulness means being in the present, intentionally and without any judgment. Mindfulness helps people cope with challenging experiences such as trauma. Children's Homes in Türkiye are institutions that provide social care to young people with past traumatic experiences. This study aims at evaluating the effects of a mindfulness-based (MB) groupwork program with a group of residents in a Children's Home. An experimental pretest-posttest control group design was used. An eight-session MB training program was implemented with 21 female adolescents. There were 29 female adolescents in the control group. The MB groupwork program significantly increased the mindfulness levels of the group. However, its effect on the other variables could not be determined at a significant level. There were positive correlations between mindfulness, life satisfaction and subjective happiness, and a negative correlation with perceived stress. The results of this study showed that MB interventions increase mindfulness levels of adolescents in a Children's Home setting in Türkiye. Secondly, as mindfulness increased, life satisfaction and subjective happiness also increased while perceived stress decreased. MB interventions are recommended to be used in social work interventions with different groups since it can contribute to subjective well-being.
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Affiliation(s)
- Irmak Atak
- Istanbul Provincial Directorate of Family and Social Services, UNEC Social Work and Social Innovations Research Center, Azerbaijan State University of Economics, Baku, Azerbaijan, Istanbul, Türkiye
| | - Taner Artan
- Faculty of Health Sciences, Department of Social Work, UNEC Social Work and Social Innovations Research Center, Istanbul University-Cerrahpaşa, Baku, Azerbaijan
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3
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Roper A, Pacas Fronza G, Dobkin RD, Beaudreau SA, Mitchell LK, Pachana NA, Thangavelu K, Dissanayaka NN. A Systematic Review of Psychotherapy Approaches for Anxiety in Parkinson's Disease. Clin Gerontol 2024; 47:188-214. [PMID: 35634720 DOI: 10.1080/07317115.2022.2074814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVES Anxiety is common in Parkinson's disease (PD), negatively impacting daily functioning and quality of life in PD patients and their families. This systematic review evaluates the effectiveness of different psychotherapeutic approaches for reducing anxiety in PD and provides recommendations for clinical practise. METHODS Following PRISMA guidelines, 36 studies were included and risk of bias was evaluated. RESULTS We identified cognitive behavioral therapy (CBT), mindfulness-based therapies, acceptance and commitment therapy, and psychodrama psychotherapies. There is good evidence-base for anxiety reduction using CBT approaches, but with mixed results for mindfulness-based therapies. Other therapeutic approaches were under researched. Most randomized control trials examined anxiety as a secondary measure. There was a paucity of interventions for anxiety subtypes. Secondarily, studies revealed the consistent exclusion of PD patients with cognitive concerns, an importance of care partner involvement, and a growing interest in remote delivery of psychotherapy interventions. CONCLUSIONS Person-centered anxiety interventions tailored for PD patients, including those with cognitive concerns, and trials exploring modalities other than CBT, warrant future investigations. CLINICAL IMPLICATIONS Practitioners should consider PD-specific anxiety symptoms and cognitive concerns when treating anxiety. Key distinctions between therapeutic modalities, therapy settings and delivery methods should guide treatment planning.
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Affiliation(s)
- Amy Roper
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Gabriela Pacas Fronza
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Roseanne D Dobkin
- Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, Piscataway, New Jersey, USA
| | - Sherry A Beaudreau
- School of Psychology, The University of Queensland, Brisbane, Australia
- Sierra Pacific Mental Illness Research, Education, and Clinical Centers (MIRECC), Palo Alto Veterans Administration Health Care System & Psychiatry and Behavioral Sciences, Stanford University School of Medicine, Stanford, California, USA
| | | | - Nancy A Pachana
- School of Psychology, The University of Queensland, Brisbane, Australia
| | - Karthick Thangavelu
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Women's Hospital, Brisbane, Australia
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4
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McDaniels B, Pontone GM, Keener AM, Subramanian I. A Prescription for Wellness in Early PD: Just What the Doctor Ordered. J Geriatr Psychiatry Neurol 2023; 36:461-469. [PMID: 36911924 DOI: 10.1177/08919887231164358] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/14/2023]
Abstract
BACKGROUND Being diagnosed with a neurodegenerative disease is a life-changing event and a critical time to help patients cope and move forward in a proactive way. Historically, the main focus of Parkinson's disease (PD) treatment has been on the motor features with limited attention given to non-motor and mental health sequelae, which have the most impact on quality of life. Although depression and anxiety have been described at the time of PD diagnosis, demoralization, intolerance of uncertainty, decreased self-efficacy, stigma and loneliness can also present and have negative effects on the trajectory of the disease. Hence, understanding the psychological impact of the diagnosis and how to provide better counselling at this critical time point may be the key to a better long-term trajectory and quality of life. FOCUS There has been a paradigm shift in the treatment of chronic illness moving beyond the medical model, which focuses on fighting illness with the physician being in charge of the treatment process and the patient being the passive recipient, toward a more holistic (i.e., physical, psychological, social, and spiritual health) biopsychosocial approach that emphasizes behavioral factors with the patient being an active collaborator in their treatment. Hence, we propose that fostering resilience, social support, and psychological flexibility offer promise toward attenuating negative reactions and improving overall well-being. CONCLUSION Through a proactive wellness approach incorporating lifestyle choices, people with PD (PwP) can not only achieve improved states of health, well-being, and quality of life, but actually thrive.
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Affiliation(s)
- Bradley McDaniels
- Department of Rehabilitation and Health Services, University of North Texas, Denton, TX, USA
| | - Gregory M Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, MD, USA
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, MD, USA
| | - Adrienne M Keener
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
- Parkinson's Disease Research, Education, and Clinical Center (PADRECC), Veterans Administration Greater Los Angeles Health Care System, Los Angeles, CA, USA
| | - Indu Subramanian
- Department of Neurology, David Geffen School of Medicine, Los Angeles, CA, USA
- Parkinson's Disease Research, Education, and Clinical Center (PADRECC), Veterans Administration Greater Los Angeles Health Care System, Los Angeles, CA, USA
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5
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Lin HW, Tam KW, Kuan YC. Mindfulness or meditation therapy for Parkinson's disease: A systematic review and meta-analysis of randomized controlled trials. Eur J Neurol 2023; 30:2250-2260. [PMID: 37158296 DOI: 10.1111/ene.15839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 03/30/2023] [Accepted: 04/16/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Parkinson's disease (PD) is the second most common neurodegenerative disorder worldwide. Mindfulness and meditation therapies have been demonstrated as effective alternative treatments for patients with neurological disorders. However, the effects of mindfulness and meditation therapies on PD remain unclear. This meta-analysis investigated the effects of mindfulness and meditation therapies in PD patients. METHODS A literature search was conducted using PubMed, Embase, Cochrane Library, and ClinicalTrials.gov for randomized controlled trials comparing mindfulness and meditation therapies with control treatments in patients with PD. RESULTS Nine articles involving eight trials were included, with a total of 337 patients. Our meta-analysis revealed that mindfulness and meditation therapies significantly improved Unified Parkinson's Disease Rating Scale-Part III score (mean difference [MD] = -6.31, 95% confidence interval [95% CI] = -8.57 to -4.05) and cognitive function (standard mean difference [SMD] = 0.62, 95% CI = 0.23 to 1.02). However, no significant differences were discovered between mindfulness therapies and control in gait velocity (MD = 0.05, 95% CI = -0.23 to 0.34), Parkinson's Disease Questionnaire-39 Summary Index (MD = 0.51, 95% CI = -1.12 to 2.14), activities of daily living (SMD = -1.65, 95% CI = -3.74 to 0.45), depression (SMD = -0.43, 95% CI = -0.97 to 0.11), anxiety (SMD = -0.80, 95% CI = -1.78 to 0.19), pain (SMD = 0.79, 95% CI = -1.06 to 2.63), or sleep disturbance (SMD = -0.67, 95% CI = -1.58 to 0.24). CONCLUSION Mindfulness and meditation therapies may serve as complementary and alternative treatments for PD patients.
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Affiliation(s)
- Ho-Wei Lin
- School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Ka-Wai Tam
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Division of General Surgery, Department of Surgery, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of General Surgery, Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei City, Taiwan
| | - Yi-Chun Kuan
- Center for Evidence-Based Health Care, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan
- Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan
- Department of Neurology, Taipei Medical University Shuang Ho Hospital, New Taipei City, Taiwan
- Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan
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6
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Kwok JYY, Auyeung M, Pang SYY, Ho PWL, Yu DSF, Fong DYT, Lin CC, Walker R, Wong SYS, Ho RTH. A randomized controlled trial on the effects and acceptability of individual mindfulness techniques - meditation and yoga - on anxiety and depression in people with Parkinson's disease: a study protocol. BMC Complement Med Ther 2023; 23:241. [PMID: 37461018 PMCID: PMC10351114 DOI: 10.1186/s12906-023-04049-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Accepted: 06/21/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Between 40 and 50% of patients with Parkinson's disease (PD) experience anxiety and depression, associated with impaired physical function, high care dependency and mortality. Recently, the United States National Institutes of Health has urged the implementation of mindfulness practices in chronic illness care. Most research to date has examined the effects on chronically ill patients of complex interventions using a combination of mindfulness techniques. In PD patients, however, such complex modalities appear to hinder the technique mastery. Hence, the aim of this trial is to investigate the effects and underlying mechanism of individual mindfulness techniques among PD patients, as well as exploring participants' experience in using individual mindfulness techniques as a lifestyle intervention for stress and symptom management. METHODS We will conduct an assessor-blind three-arm randomized waitlist-controlled trial with a descriptive qualitative evaluation. Up to 168 PD patients will be recruited from community settings and out-patient clinics, and randomized to meditation, yoga, or usual care group. Meditation and yoga sessions of 90-minute are held weekly for 8 weeks. Primary outcomes include anxiety and depression. Secondary outcomes include PD-related motor and non-motor symptoms and quality-of-life; and level of mindfulness and biomarkers of stress and inflammatory responses will be measured as mediating variables. All outcome evaluations will be assessed at baseline, 8 weeks, and 24 weeks. Following the intention-to-treat principle, generalized estimating equation models and path analysis will be used to identify the treatment effects and the mediating mechanisms. A subsample of 30 participants from each intervention group will be invited for qualitative interviews. DISCUSSION The study would also generate important insights to enhance the patients' adaptation to debilitating disease. More specifically, symptom management and stress adaptation are highly prioritized healthcare agenda in managing PD. The research evidence will further inform the development of community-based, nurse-led compassionate care models for neurodegenerative conditions, which is complementary to existing health services. TRIAL REGISTRATION WHO Primary Registry - Chinese Clinical Trials Registry number: ChiCTR2100045939; registered on 2021/04/29 ( https://www.chictr.org.cn/showproj.html?proj=125878 ).
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Affiliation(s)
- Jojo Yan Yan Kwok
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Man Auyeung
- Department of Medicine, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong SAR
| | | | - Philip Wing Lok Ho
- Division of Neurology, Department of Medicine, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hung Hom, Hong Kong SAR
- The State Key Laboratory of Marine Pollution, City University of Hong Kong, Kowloon Tong, Hong Kong SAR
| | - Doris Sau Fung Yu
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Daniel Yee Tak Fong
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Chia-chin Lin
- School of Nursing, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Richard Walker
- Northumbria Healthcare NHS Foundation Trust, North Tyneside General Hospital, Newcastle, UK
- Population Health Sciences Institute, Newcastle University, Newcastle, UK
| | - Samuel Yeung-shan Wong
- The Jockey Club School of Public Health and Primary Care, Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
- CUHK Thomas Jing Centre for Mindfulness Research and Training, The Chinese University of Hong Kong, Shatin, Hong Kong SAR
| | - Rainbow Tin Hung Ho
- Centre on Behavioral Health, The University of Hong Kong, Pokfulam, Hong Kong SAR
- Department of Social Work & Social Administration, The University of Hong Kong, Pokfulam, Hong Kong SAR
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7
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Interian A, Miller RB, Hill LMS, Latorre M, King AR, Rodriguez KM, Mann SL, Kashan RS, Dissanayaka NN, Dobkin RD. A Pilot Study of Telehealth Mindfulness-Based Cognitive Therapy for Depression in Parkinson's Disease. J Geriatr Psychiatry Neurol 2023; 36:143-154. [PMID: 35603772 DOI: 10.1177/08919887221103579] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Introduction: Parkinson's disease (PD) is characterized by high-rates of depression with limited evidence-based treatment options to improve mood. Objective: To expand therapeutic options, we evaluated the feasibility and effect of a telehealth mindfulness-based cognitive therapy intervention adapted for PD (MBCT-PD) in a sample of participants with DSM-5 depressive disorders. Methods: Fifteen participants with PD and clinically-significant depression completed 9 sessions of MBCT-PD. Depression, anxiety, and quality of life were evaluated at baseline, endpoint, and 1-month follow-up. Results: Telehealth MBCT-PD was feasible and beneficial. Completion rates exceeded 85% and treatment satisfaction rates were high. Notable improvements were observed for depression, anxiety, and quality of life over the course of the trial. Conclusion: Telehealth MBCT-PD shows promise and warrants further evaluation via randomized clinical trial with more diverse participants. Such research holds the potential to expand the range of therapeutic options for depression in PD, thereby setting the stage for personalized care.
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Affiliation(s)
- Alejandro Interian
- 20063VA New Jersey Healthcare System, Lyons, NJ, USA.,20061Rutgers-Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, USA
| | | | | | | | - Arlene R King
- 20063VA New Jersey Healthcare System, Lyons, NJ, USA
| | | | - Sarah L Mann
- 20063VA New Jersey Healthcare System, Lyons, NJ, USA
| | - Rachel S Kashan
- 20061Rutgers-Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, USA
| | - Nadeeka N Dissanayaka
- UQ Centre for Clinical Research, Faculty of Medicine, 25056The University of Queensland, Brisbane, AU-QLD, Australia.,School of Psychology, 12287University of Queensland, Brisbane, AU-QLD, Australia.,Department of Neurology, 303224Royal Brisbane & Women's Hospital, Brisbane, AU-QLD, Australia
| | - Roseanne D Dobkin
- 20061Rutgers-Robert Wood Johnson Medical School, Department of Psychiatry, Piscataway, NJ, USA
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8
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Eccles FJR, Sowter N, Spokes T, Zarotti N, Simpson J. Stigma, self-compassion, and psychological distress among people with Parkinson's. Disabil Rehabil 2023; 45:425-433. [PMID: 35171069 DOI: 10.1080/09638288.2022.2037743] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
PURPOSE People with Parkinson's disease (hereafter Parkinson's) can experience stigma through the attitudes and actions of others (enacted stigma) and through anticipation of enacted stigma and internalisation of negative stereotypes (felt stigma). Self-compassion may protect against the impact of stigma. This study aimed to investigate the relationships between self-compassion, stigma, and psychological distress among people with Parkinson's. METHODS A total of 130 people with Parkinson's completed questionnaires measuring self-compassion, enacted and felt stigma, and depression, anxiety, and stress. Correlation, mediation, and moderation models were used to investigate relationships between variables. RESULTS All variables correlated significantly in the expected directions. Felt stigma mediated the relationship between self-compassion and the three outcome variables - depression, anxiety, and stress. Self-compassion did not moderate the relationship between enacted stigma and distress and suggested enacted stigma was associated with distress, regardless of levels of self-compassion. CONCLUSIONS Self-compassion and both enacted and felt stigma are important predictors of distress for people with Parkinson's. Part of the relationship between lower self-compassion and psychological distress appears to occur via the internalisation of stigma. These findings may be relevant to the development of individualised and societal interventions with the aim of improving the psychological wellbeing of people with Parkinson's.Implications for rehabilitationSelf-compassion was associated with lower levels of psychological distress (i.e., depression, anxiety, and stress) and self-stigma partially mediated this relationship.Self-compassion did not moderate the relationship between enacted stigma and psychological distress, suggesting enacted stigma increases distress, regardless of self-compassion.The development and assessment of the effectiveness of compassion-focused interventions tailored for people with Parkinson's may be important as well as systemic stigma focused interventions.
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Affiliation(s)
- Fiona J R Eccles
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Natalie Sowter
- Division of Health Research, Lancaster University, Lancaster, UK
| | - Terry Spokes
- Bali Beginnings Addiction Treatment Centre, Sanur, Indonesia
| | - Nicolò Zarotti
- Department of Clinical Psychology, University of East Anglia, Norwich Research Park, Norwich, UK
| | - Jane Simpson
- Division of Health Research, Lancaster University, Lancaster, UK
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9
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A randomized clinical trial of mindfulness meditation versus exercise in Parkinson's disease during social unrest. NPJ Parkinsons Dis 2023; 9:7. [PMID: 36681670 PMCID: PMC9862216 DOI: 10.1038/s41531-023-00452-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2022] [Accepted: 01/06/2023] [Indexed: 01/22/2023] Open
Abstract
Clinical practice guidelines support resilience training and exercise for patients with Parkinson's disease (PD). This assessor-blinded, randomized clinical trial aimed to compare the effects of a modified mindfulness meditation program versus stretching and resistance training exercise (SRTE) in patients with mild-to-moderate PD. A total of 126 potential participants were enrolled via convenience sampling, of which 68 eligible participants were randomized 1:1 to receive eight weekly 90-min sessions of mindfulness meditation or SRTE. Compared to the SRTE group, generalized estimating equation analyses revealed that the mindfulness group had significantly better improvement in outcomes, particularly for improving depressive symptoms (d, -1.66; 95% CI, -3.31 to -0.02) at week 8 and maintaining emotional non-reactivity at week 20 (d, 2.08; 95% CI, 0.59 to 3.56). Both groups demonstrated significant immediate, small-moderate effects on cognition (effect size [d] = 0.36-0.37, p = 0.006-0.011). Compared with the SRTE, mindfulness meditation appeared to be a feasible and promising strategy for managing depressive symptoms and maintaining emotional stability, with comparable benefits on cognitive performance. To combat the psychospiritual and cognitive sequelae of social unrest and COVID-19 pandemic, the integration of mindfulness training into motor-oriented PD rehabilitation protocols is recommended to strengthen the resilience and minimize the psycho-cognitive comorbidities among patients with mild-to-moderate PD.Trial Registration: HKU Clinical Trials Registry identifier: HKUCTR-2681.
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10
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van Wamelen DJ, Rukavina K, Podlewska AM, Chaudhuri KR. Advances in the Pharmacological and Non-pharmacological Management of Non-motor Symptoms in Parkinson's Disease: An Update Since 2017. Curr Neuropharmacol 2023; 21:1786-1805. [PMID: 35293295 PMCID: PMC10514535 DOI: 10.2174/1570159x20666220315163856] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/19/2022] [Accepted: 03/10/2022] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Non-motor symptoms (NMS) are an important and ubiquitous determinant of quality of life in Parkinson's disease (PD). However, robust evidence for their treatment is still a major unmet need. OBJECTIVE This study aimed to provide an updated review on advances in pharmacological, nonpharmacological, and exercise-based interventions for NMS in PD, covering the period since the publication of the MDS Task Force Recommendations. METHODS We performed a literature search to identify pharmacological, non-pharmacological, and exercise-based interventions for NMS in PD. As there are recent reviews on the subject, we have only included studies from the 1st of January 2017 to the 1st of December 2021 and limited our search to randomised and non-randomised (including open-label) clinical trials. RESULTS We discuss new strategies to manage NMS based on data that have become available since 2017, for instance, on the treatment of orthostatic hypotension with droxidopa, several dopaminergic treatment options for insomnia, and a range of non-pharmacological and exercise-based interventions for cognitive and neuropsychiatric symptoms, pain, and insomnia and excessive sleepiness. CONCLUSION Recent evidence suggests that targeted non-pharmacological treatments, as well as some other NMS management options, may have a significant beneficial effect on the quality of life and need to be considered in the pathways of treatment of PD.
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Affiliation(s)
- Daniel J. van Wamelen
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
- Department of Neurology, Radboud University Medical Center, Donders Institute for Brain, Cognition, and Behaviour, Centre of Expertise for Parkinson & Movement Disorders, Nijmegen, the Netherlands
| | - Katarina Rukavina
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - Aleksandra M. Podlewska
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
| | - K. Ray Chaudhuri
- Department of Basic & Clinical Neuroscience, Institute of Psychiatry, Psychology & Neuroscience, Division of Neuroscience, King’s College London, London, United Kingdom
- Parkinson Foundation Centre of Excellence at King’s College Hospital NHS Foundation Trust, London, United Kingdom
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11
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Online Mindfulness-Based Cognitive Therapy for People with Parkinson’s Disease and Their Caregivers: a Pilot Study. JOURNAL OF TECHNOLOGY IN BEHAVIORAL SCIENCE 2022; 7:381-395. [PMID: 35527798 PMCID: PMC9059916 DOI: 10.1007/s41347-022-00261-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 04/16/2022] [Accepted: 04/22/2022] [Indexed: 12/01/2022]
Abstract
Anxiety and depression are common non-motor symptoms of Parkinson’s disease (PD). Caregivers of people with PD may experience severe caregiver burden. This study explored the feasibility and potential benefits of an online mindfulness-based cognitive therapy (MBCT) intervention for improving anxiety and depressive symptoms in people with PD and their caregivers (ClinicalTrials.gov NCT04469049, 7/8/2020). People with PD or parkinsonism and anxiety and/or depressive symptoms and caregivers of people with PD participated in one of three online MBCT groups. Demographic variables, pre- and post-MBCT behavioral measures (GAD-7, PHQ-9, Five Facet Mindfulness Questionnaire — FFMQ-15, Caregiver Self-Assessment Questionnaire — CSAQ), and satisfaction surveys were collected. Descriptive statistics were used to summarize data. Pre- and post-MBCT behavioral scores were compared using mixed-effect models. Fifty-six potential participants were assessed for eligibility. Twenty-eight entered MBCT groups; all but one completed the intervention. The overall sample analyzed (22 people with PD, 4 caregivers) showed significant GAD-7 and PHQ-9 score reductions and FFMQ-15 total and observing and non-reactivity subscale score increases (all p’s < 0.05). Participants with PD and anxiety symptoms (n = 14) had a significant GAD-7 score reduction; those with PD and depressive symptoms (n = 12) had a significant PHQ-9 score reduction (both p’s < 0.05). Participants with PD also had a significant FFMQ-15 observing subscale score increase (p < 0.05). The caregiver sample was too small to be analyzed separately. Online MBCT is feasible (as measured by high attendance, completion rate, and participant satisfaction) and may be effective in improving anxiety and depressive symptoms in people with PD.
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12
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Zarotti N, Eccles FJR, Foley JA, Paget A, Gunn S, Leroi I, Simpson J. Psychological interventions for people with Parkinson's disease in the early 2020s: Where do we stand? Psychol Psychother 2021; 94:760-797. [PMID: 33174688 DOI: 10.1111/papt.12321] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 09/27/2020] [Indexed: 02/06/2023]
Abstract
PURPOSE To explore the heterogeneity of the literature on psychological interventions for psychological difficulties in people with Parkinson's disease (PD). METHODS A scoping review was performed across five major databases (MEDLINE Complete, PsycINFO, CINAHL, Academic Search Ultimate, and Cochrane Library) up to June 2020. RESULTS From an initial return of 4911 citations, 56 studies were included, of which 21 were RCTs. A relatively wide range of therapeutic models have been adopted with people with PD, from common therapies such as cognitive behavioural therapy (CBT) and mindfulness, to less frequent approaches, for example, acceptance and commitment therapy (ACT) and psychodrama. The clinical implications of the findings are discussed, and suggestions are provided for future research on intervention studies and key psychological outcomes. CONCLUSIONS CBT appears to be effective in treating depression and sleep disorders in people with PD, while psychoeducation programmes alone should be avoided. The use of CBT to improve anxiety, quality of life, and impulse control, as well mindfulness-based interventions, should be undertaken with some caution because of insufficient research and inconsistent results. As we enter the new decade, more high-quality evidence is required for psychological interventions in people with PD in general and to corroborate preliminary positive findings on the adoption of less frequent approaches such as ACT. PRACTITIONER POINTS Parkinson's disease is a progressive neurodegenerative condition associated with several psychological difficulties which be targeted by psychological interventions. Currently, cognitive behavioural therapy (CBT) can be recommended to treat depression and sleep disorders in people with Parkinson's, while psychoeducation alone should be avoided. Caution is advised regarding the use of CBT and mindfulness-based interventions to improve anxiety, quality of life, and impulse control. Further evidence is required for less common approaches, such as acceptance and commitment therapy, psychodrama, and EMDR.
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Affiliation(s)
- Nicolò Zarotti
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, UK
| | - Fiona J R Eccles
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, UK
| | - Jennifer A Foley
- Department of Neuropsychology, National Hospital of Neurology & Neurosurgery, London, UK.,UCL Queen Square Insitute of Neurology, Queen Square, London, UK
| | - Andrew Paget
- Department of Neuropsychology, National Hospital of Neurology & Neurosurgery, London, UK.,UCL Queen Square Insitute of Neurology, Queen Square, London, UK
| | - Sarah Gunn
- Department of Neuroscience, Psychology and Behaviour, University of Leicester, UK
| | - Iracema Leroi
- Global Brain Health Institute, Trinity College Dublin, Ireland
| | - Jane Simpson
- Division of Health Research, Faculty of Health and Medicine, Lancaster University, UK
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13
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Benz HL, Caldwell B, Ruiz JP, Saha A, Ho M, Christopher S, Bardot D, Sheehan M, Donnelly A, McLaughlin L, Mange B, Hauber AB, Gwinn K, Heetderks WJ, Sheldon M. Patient-Centered Identification of Meaningful Regulatory Endpoints for Medical Devices to Treat Parkinson's Disease. MDM Policy Pract 2021; 6:23814683211021380. [PMID: 34277950 PMCID: PMC8255597 DOI: 10.1177/23814683211021380] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2019] [Accepted: 04/30/2021] [Indexed: 11/16/2022] Open
Abstract
Introduction. A growing literature has developed on identifying outcomes that matter to patients. This study demonstrates an approach involving patient and regulatory perspectives to identify outcomes that are meaningful in the context of medical devices for Parkinson’s disease (PD). Methods. A systematic process was used for specifying relevant regulatory endpoints by synthesizing inputs of various sources and stakeholders. First, a literature review was conducted to identify important benefits, risks, and other considerations for medical devices to treat PD; patient discussion groups (n = 6) were conducted to refine the list of considerations, followed by a survey (n = 29) to prioritize them; and patient and Food and Drug Administration (FDA) reviewers informed specification of the final endpoints. Two FDA clinicians gave clinical and regulatory perspectives at each step. Results. Movement symptoms were ranked as most important (ranked 1 or 2 by 72% of participants) and psychological and cognitive symptoms as the next most important (ranked 1 or 2 by 52% of participants). Within movement symptoms, falls, impaired movement, bradykinesia, resting tremor, stiffness, and rigidity were ranked highly. Overall, nine attributes were identified and prioritized as patient-centric for use in clinical trial design and quantitative patient preference studies. These attributes were benefits and risks related to therapeutics for PD as well as other considerations, including time until a medical device is available for patient use. Discussion. This prospective approach identified meaningful and relevant benefits, risks, and other considerations that may be used for clinical trial design and quantitative patient preference studies. Although PD was the focus of this study, the approach can be used to study patient perspectives about other disease or treatment areas.
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Affiliation(s)
- Heather L Benz
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | - Brittany Caldwell
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | - John P Ruiz
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | - Anindita Saha
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | - Martin Ho
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | | | - Dawn Bardot
- Medical Device Innovation Consortium, Arlington, Virginia
| | - Margaret Sheehan
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | - Anne Donnelly
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | - Lauren McLaughlin
- The Michael J. Fox Foundation for Parkinson's Research, New York, New York
| | - Brennan Mange
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - A Brett Hauber
- RTI Health Solutions, Research Triangle Park, North Carolina
| | - Katrina Gwinn
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
| | | | - Murray Sheldon
- US FDA Center for Devices and Radiological Health, Silver Spring, Maryland
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14
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Shah-Zamora D, Allen AM, Rardin L, Ivancic M, Durham K, Hickey P, Cooney JW, Scott BL, Mantri S. Mindfulness based stress reduction in people with Parkinson's disease and their care partners. Complement Ther Clin Pract 2021; 43:101377. [PMID: 33831804 DOI: 10.1016/j.ctcp.2021.101377] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 03/05/2021] [Accepted: 03/26/2021] [Indexed: 02/07/2023]
Abstract
BACKGROUND Parkinson's Disease (PD) leads to poor quality of life and caregiver burden. Mindfulness-based stress reduction (MBSR) may improve these symptoms. We assessed the impact of a 9-week MBSR course on people with PD (PwP) and their care partners (CPs). METHODS Participants completed questionnaires at screening, at the end of the course, and at 3-month follow-up: Parkinson's Disease Quality-39 (PDQ-39, PD only), Zarit Burden Inventory (ZBI, CP only) and Mindful Attention Awareness Scale (MAAS, both). The primary outcome measure was change in PDQ-39 (for PwP) or ZBI (for CP). Patient-reported scales were analyzed quantitatively; qualitative data on perceived effectiveness was collected. RESULTS 53.8% PwP and 100% CPs completed the course. Among PwP, there was a significant reduction in MAAS(p < 0.001) and in PDQ-39 (p = 0.008). CPs experienced an increase in MAAS (p = 0.02) but no change in ZBI (p = 0.239). Qualitatively, both PwP and CPs expressed satisfaction with the course. DISCUSSION MBSR improves mindful awareness in CPs and improves health-related quality of life in PwP.
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Affiliation(s)
| | - Allison M Allen
- Duke University Hospital (DUH) Case Management, Duke Health, USA
| | - Lacy Rardin
- Duke University Hospital (DUH) Case Management, Duke Health, USA
| | - Margaret Ivancic
- Duke University Hospital (DUH) Case Management, Duke Health, USA
| | - Katie Durham
- Duke University Hospital (DUH) Case Management, Duke Health, USA
| | - Patrick Hickey
- Department of Neurology, Duke University School of Medicine, USA
| | - Jeffrey W Cooney
- Department of Neurology, Duke University School of Medicine, USA
| | - Burton L Scott
- Department of Neurology, Duke University School of Medicine, USA
| | - Sneha Mantri
- Department of Neurology, Duke University School of Medicine, USA.
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15
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Stress and mindfulness in Parkinson's disease - a survey in 5000 patients. NPJ PARKINSONS DISEASE 2021; 7:7. [PMID: 33462213 PMCID: PMC7813889 DOI: 10.1038/s41531-020-00152-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/03/2020] [Accepted: 12/01/2020] [Indexed: 02/07/2023]
Abstract
Many Parkinson’s disease (PD) patients notice that motor symptoms worsen during stress, and experience stress-related neuropsychiatric symptoms such as anxiety and depression. Here we investigated which personal and disease characteristics are associated with perceived stress in PD, which PD symptoms are sensitive to stress, and we assessed self-reported benefits of stress-reducing strategies such as mindfulness. We sent an online survey to the Fox Insight cohort (n = 28,385 PD patients, n = 11,413 healthy controls). The survey included specific questions about the influence of stress on PD symptoms, use of stress-reducing strategies, and several validated scales measuring perceived stress, anxiety, dispositional mindfulness, rumination, and self-compassion. We received completed surveys from 5000 PD patients and 1292 controls. Patients perceived more stress than controls. Among patients, stress was correlated with increased rumination (R = 0.65), lower quality of life (R = −0.56), lower self-compassion (R = −0.65), and lower dispositional mindfulness (R = −0.48). Furthermore, patients indicated that stress significantly worsened both motor symptoms – especially tremor – and non-motor symptoms. Physical exercise was most frequently used to reduce stress (83.1%). Mindfulness was practiced by 38.7% of PD respondents, who noticed improvement in both motor and non-motor symptoms. Among non-users, 43.4% were interested in gaining mindfulness skills. We conclude that PD patients experience greater levels of stress than controls, and that stress worsens both motor and non-motor symptoms. Mindfulness may improve PD symptom severity, with the strongest effects on anxiety and depressed mood. These findings justify further controlled studies to establish the merits of mindfulness and other stress-alleviating interventions.
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16
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van der Heide A, Meinders MJ, Speckens AE, Peerbolte TF, Bloem BR, Helmich RC. Stress and Mindfulness in Parkinson's Disease: Clinical Effects and Potential Underlying Mechanisms. Mov Disord 2021; 36:64-70. [PMID: 33094858 PMCID: PMC7894549 DOI: 10.1002/mds.28345] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Revised: 09/09/2020] [Accepted: 10/03/2020] [Indexed: 01/17/2023] Open
Abstract
Patients with Parkinson's disease (PD) are very vulnerable to the negative effects of psychological distress: neuropsychiatric symptoms, such as anxiety and depression, are highly prevalent in PD; motor symptoms (such as tremor) typically worsen in stressful situations; and dopaminergic medication is less effective. Furthermore, animal studies of PD suggest that chronic stress may accelerate disease progression. Adequate self-management strategies are therefore essential to reduce the detrimental effects of chronic stress on PD. Mindfulness-based interventions encourage individuals to independently self-manage and adapt to the challenges created by their condition. In PD, emerging clinical evidence suggests that mindfulness-based interventions may reduce psychological distress and improve clinical symptoms, but insight into the underlying mechanisms is lacking. In this viewpoint, we provide a systematic overview of existing mindfulness trials in PD. Furthermore, we discuss the cerebral mechanisms involved in acute and chronic stress, and the impact of mindfulness-based interventions on these networks. In addition, we delineate a hypothetical mechanistic framework of how chronic stress may increase the susceptibility for neuropsychiatric symptoms in PD and may potentially even influence disease progression. We end with offering recommendations for future research. © 2020 The Authors. Movement Disorders published by Wiley Periodicals LLC on behalf of International Parkinson and Movement Disorder Society.
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Affiliation(s)
- Anouk van der Heide
- Department of Neurology, Centre of Expertise for Parkinson & Movement DisordersRadboud University Medical CentreNijmegenthe Netherlands
- Donders Institute for Brain, Cognition, and Behavior, Centre for Cognitive NeuroimagingRadboud University NijmegenNijmegenthe Netherlands
| | - Marjan J. Meinders
- Radboud Institute for Health SciencesRadboud University Medical CentreNijmegenthe Netherlands
| | - Anne E.M. Speckens
- Radboud University Medical CentreDepartment of Psychiatry, Centre for MindfulnessNijmegenthe Netherlands
| | - Tessa F. Peerbolte
- Donders Institute for Brain, Cognition, and Behavior, Centre for Cognitive NeuroimagingRadboud University NijmegenNijmegenthe Netherlands
| | - Bastiaan R. Bloem
- Department of Neurology, Centre of Expertise for Parkinson & Movement DisordersRadboud University Medical CentreNijmegenthe Netherlands
| | - Rick C. Helmich
- Department of Neurology, Centre of Expertise for Parkinson & Movement DisordersRadboud University Medical CentreNijmegenthe Netherlands
- Donders Institute for Brain, Cognition, and Behavior, Centre for Cognitive NeuroimagingRadboud University NijmegenNijmegenthe Netherlands
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17
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18
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Buchwitz TM, Maier F, Greuel A, Eggers C. Improving Self-Awareness of Motor Symptoms in Patients With Parkinson's Disease by Using Mindfulness - A Study Protocol for a Randomized Controlled Trial. Front Psychol 2020; 11:743. [PMID: 32362861 PMCID: PMC7180229 DOI: 10.3389/fpsyg.2020.00743] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 03/26/2020] [Indexed: 12/23/2022] Open
Abstract
Objective This study aims to increase self-awareness in patients with Parkinson’s disease (PD) using a newly developed mindfulness-based intervention, tailored for the specific needs of PD patients. Its impact on self-awareness and patients’ daily lives is currently being evaluated. Background Recently, the phenomenon of impaired self-awareness for motor symptoms (ISAm) and some non-motor symptoms has been described in PD. ISAm can negatively influence patients’ daily lives, e.g., by affecting therapy adherence, and is therefore the main focus of this study. The main goal is the development of IPSUM (“Insight into Parkinson’s Disease Symptoms by using Mindfulness”), a PD-specific intervention for increasing patients’ mindfulness and thereby reducing ISAm. Methods The effectiveness of IPSUM is evaluated by comparison of an intervention group with a waitlist-control group. A pre-post design with an additional 8-week follow-up measurement is applied, resulting in three measurement points: before, directly after and 8 weeks after completing the intervention protocol. In total, up to 180 non-depressed PD patients without severe cognitive impairment (non-demented) will be included. The primary outcome is a quantitative score for measuring ISAm. Secondary outcome measures are affective changes, neuropsychological performance and self-awareness of cognition. At pre- and post-measurement an fMRI scan is performed to connect behavioral and neurobiological findings. At post- and follow-up-measurement each patient will take part in a semi-structured interview to explore IPSUM’s impact on self-awareness and patients’ everyday lives. Results The conception of the intervention protocol is finished, the resulting 8-week program is presented in detail. It has successfully been tested in the first group of patients, their feedback so far was quite promising. Recruitment is ongoing and a first interim analysis will be performed once 30 patients have completed IPSUM. Conclusion For the first time, the intervention protocol of IPSUM has successfully been tested in a group of PD patients. As the study goes on, more quantitative data is collected for statistical analyses to evaluate its effectiveness. More qualitative data is collected to evaluate feasibility and effectiveness. We hope for this intervention to be capable of reducing the patients’ ISAm and improving their quality of life on many levels.
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Affiliation(s)
| | - Franziska Maier
- Department of Psychiatry, University Hospital Cologne, Medical Faculty, Cologne, Germany
| | - Andrea Greuel
- Department of Neurology, University Hospital Marburg, Marburg, Germany
| | - Carsten Eggers
- Department of Neurology, University Hospital Marburg, Marburg, Germany.,Center for Mind, Brain and Behavior, University of Marburg, Marburg, Germany
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19
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Peña-Bautista C, Casas-Fernández E, Vento M, Baquero M, Cháfer-Pericás C. Stress and neurodegeneration. Clin Chim Acta 2020; 503:163-168. [PMID: 31987795 DOI: 10.1016/j.cca.2020.01.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2019] [Revised: 01/20/2020] [Accepted: 01/21/2020] [Indexed: 12/13/2022]
Abstract
Neurodegenerative diseases are a great concern because of aging worldwide population. Despite substantial effort to advance our understanding of the etiology and potential treatment of neurodegeneration, there remains a paucity of information with respect to this complex disease process. Interestingly, stress has been implicated among the potential mechanisms implicated in neurodegenerative pathology. Given the increase in chronic stress in modern society, this premise warrants further investigation. The aim of this review is to evaluate the influence of stress on neurodegeneration, the effect of neurodegenerative diseases diagnosis on stress, and therapeutic strategies for neurodegenerative diseases with a special focus on stress reduction. Neurodegenerative disorders such as Alzheimer's, Parkinson's and Huntington's Disease showed an acceleration in disease progression and a worsening of symptoms under stress. Some therapies (e.g., yoga, meditation) focused on reducing stress showed beneficial effects against neurodegeneration. Nevertheless, more studies are necessary in order to completely understand the implications of stress in neurodegeneration and the usefulness of stress reduction in the treatment thereof.
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Affiliation(s)
| | | | - Máximo Vento
- Health Research Institute La Fe, Valencia, Spain
| | - Miguel Baquero
- Division of Neurology, University and Polytechnic Hospital La Fe, Valencia, Spain
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20
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Pontone GM, Dissanayaka N, Apostolova L, Brown RG, Dobkin R, Dujardin K, Friedman JH, Leentjens AFG, Lenze EJ, Marsh L, Mari L, Monchi O, Richard IH, Schrag A, Strafella AP, Vernaleo B, Weintraub D, Mari Z. Report from a multidisciplinary meeting on anxiety as a non-motor manifestation of Parkinson's disease. NPJ Parkinsons Dis 2019; 5:30. [PMID: 31840044 PMCID: PMC6906437 DOI: 10.1038/s41531-019-0102-8] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Accepted: 10/17/2019] [Indexed: 12/14/2022] Open
Abstract
Anxiety is a severe problem for at least one-third of people living with Parkinson's disease (PD). Anxiety appears to have a greater adverse impact on quality of life than motor impairment. Despite its high prevalence and impact on daily life, anxiety is often undiagnosed and untreated. To better address anxiety in PD, future research must improve knowledge about the mechanism of anxiety in PD and address the lack of empirical evidence from clinical trials. In response to these challenges, the Parkinson's Foundation sponsored an expert meeting on anxiety on June 13th and 14th 2018. This paper summarizes the findings from that meeting informed by a review of the existing literature and discussions among patients, caregivers, and an international, clinician-scientist, expert panel working group. The goal is to provide recommendations to improve our understanding and treatment of anxiety in PD.
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Affiliation(s)
- Gregory M. Pontone
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University School of Medicine, Baltimore, MD USA
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD USA
| | - Nadeeka Dissanayaka
- The University of Queensland Centre for Clinical Research, Faculty of Medicine, Brisbane, Australia
- School of Psychology, The University of Queensland, Brisbane, Australia
- Department of Neurology, Royal Brisbane & Woman’s Hospital, Brisbane, Australia
| | - Liana Apostolova
- Department of Neurology, Indiana University School of Medicine, Indianapolis, IN USA
| | - Richard G. Brown
- Department of Psychology, Institute of Psychiatry Psychology and Neuroscience, King’s College London, London, UK
- South London and Maudsley NHS Foundation Trust, London, UK
| | - Roseanne Dobkin
- Department of Psychiatry, Rutgers University, Robert Wood Johnson Medical School, Piscataway, NJ USA
| | - Kathy Dujardin
- Department of Neurology and Movement Disorders, Lille University Medical Center, Lille, France
| | - Joseph H. Friedman
- Movement Disorders Program, Butler Hospital; Department of Neurology, Warren Alpert Medical School of Brown University, Providence, RI USA
| | - Albert F. G. Leentjens
- Department of Psychiatry, Maastricht University Medical Center, Maastricht, the Netherlands
| | - Eric J. Lenze
- Department of Psychiatry, Washington University School of Medicine, St. Louis, MO USA
| | - Laura Marsh
- Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX USA
- Department of Psychiatry, Baylor College of Medicine, Houston, TX USA
| | - Lynda Mari
- Person Holistic Innovation, Las Vegas, NV USA
| | - Oury Monchi
- Departments of Clinical Neurosciences and Radiology, Hotchkiss Brain Institute, University of Calgary, Calgary, Canada
| | - Irene H. Richard
- Department of Neurology, University of Rochester Medical Center, Rochester, NY USA
| | - Anette Schrag
- Department of Clinical and Movement Neurosciences, University College London, London, UK
| | - Antonio P. Strafella
- E.J. Safra Parkinson Disease Program, Toronto Western Hospital & Krembil Research Institute, UHN; Research Imaging Centre, Campbell Family Mental Health Research Institute, CAMH; University of Toronto, Ontario, Canada
| | | | - Daniel Weintraub
- Departments of Psychiatry and Neurology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA USA
- Parkinson’s Disease Research, Education and Clinical Center, Philadelphia Veterans Affairs Medical Center, Philadelphia, PA USA
| | - Zoltan Mari
- Cleveland Clinic Lou Ruvo Center for Brain Health, Movement Disorders Program, Las Vegas, NV USA
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21
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Donley S, McGregor S, Wielinski C, Nance M. Use and perceived effectiveness of complementary therapies in Parkinson's disease. Parkinsonism Relat Disord 2018; 58:46-49. [PMID: 30245174 DOI: 10.1016/j.parkreldis.2018.08.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 07/26/2018] [Accepted: 08/06/2018] [Indexed: 12/13/2022]
Abstract
INTRODUCTION Complementary therapies are commonly used by people with Parkinson's disease to relieve symptoms not fully addressed by pharmacologic and rehabilitation therapies currently available through medical clinics and programs. Three prior surveys in the US have shown that 40-85% of patients have used complementary therapies. We were interested in understanding what complementary therapies (CTs) our patients had used, to treat what symptoms, and whether they felt that the treatments were effective. METHODS Patients scheduled for a return visit to a center neurologist were mailed a survey and instructed to bring the completed survey to their clinic visit. The survey contained questions on CTs used, effectiveness, and for what symptoms was the CT helpful. Willingness to participate in CT research was also included in the survey. RESULTS 272 of 435 people with Parkinson's disease who completed the survey (62.5%) had tried some kind of CT, including a higher proportion of women than men (75.7% vs 53.8%; p < 0.01). Massage was the most frequently used therapy followed by yoga, Tai Chi, meditation and acupuncture. A high proportion of patients found the CT to be effective, for instance meditation was viewed as helpful by 85% of patients. Almost 2/3 of patients said they would be willing to participate in a research study of a CT. CONCLUSIONS Complementary therapies are frequently used by people with Parkinson's disease coming to our center, and are viewed to be helpful for both motor and non-motor symptoms. Formal research assessments of therapies such as meditation are warranted.
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Affiliation(s)
- Sarah Donley
- Struthers Parkinson's Center, 6701 Country Club Drive, Golden Valley, MN USA.
| | - Sadie McGregor
- Struthers Parkinson's Center, 6701 Country Club Drive, Golden Valley, MN USA.
| | - Catherine Wielinski
- Struthers Parkinson's Center, 6701 Country Club Drive, Golden Valley, MN USA.
| | - Martha Nance
- Struthers Parkinson's Center, 6701 Country Club Drive, Golden Valley, MN USA.
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