Diagnosis, treatment and management of apathy in Parkinson’s disease: a scoping review

Abstract

ObjectiveTo conduct a scoping review of the literature on apathy in Parkinson’s disease (PD), to better understand how apathy in Parkinson’s disease is diagnosed, treated and managed.MethodsMEDLINE, Embase, PsycINFO, CINAHL, Cochrane Central Register of Control Trials and Cochrane Database of Systematic Reviews were searched to 17 May 2017. An updated review was run from 17 May 2017 to 28 January 2019. The grey literature was searched using the CADTH Grey Matters tool. Original peer-reviewed research was included if it included individuals with PD and apathy. Non-original data was only included if it was in the form of meta-analysis. All information regarding diagnosis, treatment and management of PD was extracted. Citation screening and extraction were performed in duplicate.ResultsFrom 11 375 citations, 362 articles were included in the final review. The majority of included studies focussed on prevalence, with few studies examining treatment. Twenty screening tools for apathy were identified. Fifty per cent of treatment studies were randomised control trials (RCTs). RCTs applied treatment methods including: exercise, mindfulness, rotigotine (Neupro) transdermal patch and rivastigmine (Exelon).ConclusionsThis review identified a large body of literature describing current knowledge on diagnosing, treating and managing apathy in PD. Future research should aim to detect an ideal screening tool for apathy in PD, to identify the best treatment options for apathy and the variety of comorbidities it may present with and finally aim to better understand postoperative apathy in those with deep brain stimulation.

Non-pharmacologic interventions to treat apathy in Parkinson’s disease: A realist review

“…The initial scoping review search yielded 1664 studies and the updated search conducted May 20, 2020, yielded an additional 479 studies [20] . In total, nine studies were included in our final synthesis.…”

“…The initial scoping search, as informed by an earlier scoping review of the literature on apathy in PD [20] , was originally searched from inception to January 2019. Any study classified as a non-pharmacologic intervention for persons with apathy in PD informed the development of a rough programme theory.…”

“…All study designs were included if they used a non-pharmacologic intervention to treat apathy in PD, either as a primary or secondary outcome, and were published in the English language. Initial treatment studies were identified by a previous scoping review on apathy in PD [20] . Two authors independently screened titles and abstracts for the initial scoping search (B.M., Z.G.)…”

How COVID-19 will boost remote exercise-based treatment in Parkinson’s disease: a narrative review

“…A huge challenge associated with unsupervised activity is the lack of motivation to start and keep a regular exercise regime. Apathy in PD patients can further aggravate demotivation, though exercise itself reduces apathy and fatigue 18,21,[78][79][80][81] . The World Health Organization (WHO) recommends measures to promote motivation not only at the professional level by health professionals but also at the community level (formation of training groups) and the personal level by promoting the patient's rights of self-determination 82 .…”

A randomised controlled trial on effectiveness and feasibility of sport climbing in Parkinson’s disease

“…Any success of exercise is determined by a regular routine, which requires a high level of motivation from the patient 25 . Engaging and motivating sports are essential to overcome apathy; a state of mind that prevails in patients suffering from PD and interferes with long-term adherence to physical exercise 26 – 30 . To widen the range of attractive sports for PD patients, alternative sports such as dancing, boxing, Tai Chi and yoga are currently on the rise and have already shown substantial effects on motor symptoms 31 – 36 .…”