Multidisciplinary intensive rehabilitation treatment improves sleep quality in Parkinson’s disease

Abstract

BackgroundSleep disturbances are among the most common non-motor symptoms of Parkinson’s disease (PD), greatly interfering with daily activities and diminishing life quality. Pharmacological treatments have not been satisfactory because of side effects and interactions with anti-parkinsonian drugs. While studies have shown that regular exercise improves sleep quality in normal aging, there is no definitive evidence in PD.MethodsIn a retrospective study, we determined whether an intense physical and multidisciplinary exercise program improves sleep quality in a large group of patients with PD.We analyzed the scores of PD Sleep Scale (PDSS), which was administered twice, 28 days apart, to two groups of patients with PD of comparable age, gender, disease duration and pharmacological treatment. The control group (49 patients) did not receive rehabilitation, The treated group (89 patients) underwent a 28-day multidisciplinary intensive rehabilitation program (three one-hour daily sessions comprising cardiovascular warm-up, relaxation, muscle-stretching, balance and gait training, occupational therapy to improve daily living activities).ResultsAt enrolment, control and treated groups had similar UPDRS and PDSS scores. At re-test, 28 days later, UPDRS and total PDSS scores improved in the treated (p < 0.0001) but not in the control group. In particular, the treated group showed significant improvement in PDSS scores for sleep quality, motor symptoms and daytime somnolence. The control group did not show improvement for any item.ConclusionsThese results suggest that multidisciplinary intensive rehabilitation treatment may have a positive impact on many aspects of sleep in PD.

Intensive Rehabilitation Enhances Lymphocyte BDNF-TrkB Signaling in Patients With Parkinson’s Disease

“…A more general improvement in plasticity might be obtained by aerobic exercise, as suggested by recent studies in normal animals [13], in animal model of PD [14], in normal human subjects [15] and in patients with neurodegenerative diseases [16]. In particular, the Multidisciplinary Intensive Rehabilitation Treatment (MIRT), a four-week protocol that includes aerobic exercise as well as functional and goal-directed training [17–21], produces a long-lasting improvement on the motor and non-motor functions of patients with PD [22–25]. Specifically, in a two-year study, the comparison between two groups of patients in the early stages of PD treated with the same amount of rasagiline revealed that UPDRS II and III scores as well as other clinical parameters progressed more slowly in the MIRT group [25].…”

Non‐pharmacological therapies for sleep disturbances in people with Parkinson's disease: A systematic review

“…In this review, we found that mild to moderate multimodal exercise programmes lasting for over 6 months attenuated insomnia and EDS (Nascimento et al., ). Consistent with these findings, one retrospective study reported a positive effect of physical exercise on sleep quality and daytime somnolence in people with PD (Frazzitta et al., ). However, few clinical trials on the effects of physical activity for sleep disturbances have been performed in people with PD.…”

“…Collectively, these sleep‐related problems cause fatigue, morning headaches, and cognitive and mood disturbances including depression, which may lead to a loss of productivity, work‐related accidents and withdrawal from social activities (Buttaro, Trybulski, Polgar‐Bailey, & Sandberg‐Cook, ). Clearly, sleep complaints and sleep‐related problems interfere with daily activities and motor skills and ultimately negatively affect a person's QOL (Frazzitta et al., ; Happe & Berger, ; Silvestri, ).…”

The role and structure of the multidisciplinary team in the management of advanced Parkinson&rsquo;s disease with a focus on the use of levodopa&ndash;carbidopa intestinal gel

“…Available studies show that people with PD and their caregivers benefit from joined-up multidisciplinary care, although the number of reports in this area is still limited and very few controlled studies are available 1–8,10,11,56–58. The key to the optimal management of people with PD at all stages of the disease, and successful implementation of advanced therapies, is an effective MDT approach, such as those models described in this paper.…”

“…Intensive multidisciplinary rehabilitation interventions for people with PD are particularly effective at improving QoL and motor function 1–8,10,11,56–58. Although investment in such initiatives might prevent future costs attributed to disabling motor symptoms (eg, falls, loss of independence),58 innovative solutions should be considered to ensure such interventions can continue in the long-term, such as the Düsseldorf Parkinson network telemedicine care program.…”