Non-pharmacological treatment for Parkinson disease patients with depression: a meta-analysis of repetitive transcranial magnetic stimulation and cognitive-behavioral treatment

Chen, Jianing; He, Peikun; Zhang, Yuhu; Gao, Yuyuan; Qiu, Yihui; Li, You; Zhang, Qingxi; Wang, Limin; Huang, Zhiheng; Zhao, Jing; Nie, Kun

doi:10.1080/00207454.2020.1744591

Cited by 14 publications

(9 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Whether rTMS over DLPFC benefited motor symptoms was unsettled mainly because of various rTMS parameters (e.g., target selection, frequency, intensity, and total stimulus) and study participants. In the current trial, active rTMS group showed significant improvement in motor performance, which was similar to results from some meta-analyses [ 11 , 22 ] examining the efficacy of either low frequency over right DLPFC or high frequency over left DLPFC on the motor symptom. Although the exact mechanisms remained elucidated, a reasonable explanation might be due to the release of dopamine in the striatum resulting from sustained stimulation on DLPFC via the frontal-striatal-cortical pathways [ 23 , 24 ] in promoting global motor performance.…”

Section: Discussionsupporting

confidence: 88%

Low-Frequency Repetitive Transcranial Magnetic Stimulation over Right Dorsolateral Prefrontal Cortex in Parkinson’s Disease

Zhuang

Wang²,

et al. 2020

Parkinson's Disease

View full text Add to dashboard Cite

Background. Repetitive transcranial magnetic stimulation (rTMS) is a promising therapeutic tool for Parkinson’s disease (PD), and many stimulation targets have been implicated. We aim to explore whether low-frequency rTMS over the right dorsolateral prefrontal cortex (DLPFC) improves motor and nonmotor symptoms of individuals with PD. Methods. We conducted a randomized, single-blind, sham-controlled parallel trial to compare the effect of 10 consecutive daily sessions of 1 Hz rTMS over right DLPFC on individuals with idiopathic PD between active and sham rTMS group. Primary outcomes were changes in Unified Parkinson’s Disease Rating Scale (UPDRS) part III and Nonmotor Symptom Questionnaire (NMSQ). Secondary outcomes were changes in UPDRS total score, Hamilton Rating Scale for Depression (HRSD), Pittsburgh Sleep Quality Index (PSQI), and Montreal Cognitive Assessment (MoCA). Assessments were completed at baseline, after treatment, and at 1 month, 3 months, and 6 months after treatment. Results. A total of 33 participants with PD were randomized. All participants completed the study and no severe adverse effect was noticed. Compared to baseline, active rTMS showed significant improvements in UPDRS part III and NMSQ at 1 month. Change of scores on UPDRS part III, HRSD, and PSQI persisted for 3 months after rTMS intervention. The beneficial effect on cognitive performance assessed by MoCA was maintained for at least 6 months in the follow-up. No significant changes were observed in the group with sham rTMS. Conclusions. Low-frequency rTMS of right DLPFC could be a potential selection in managing motor and nonmotor symptoms in PD.

show abstract

Section: Discussionsupporting

confidence: 88%

Low-Frequency Repetitive Transcranial Magnetic Stimulation over Right Dorsolateral Prefrontal Cortex in Parkinson’s Disease

Zhuang

Wang²,

et al. 2020

Parkinson's Disease

View full text Add to dashboard Cite

show abstract

“…In addition, randomized clinical trials consistently demonstrated the effectiveness of cognitive behavioral therapy in depressed patients with PD [21,288]. Interestingly, use of telemedicine with video-to-home cognitive behavioral therapy was recently demonstrated to be an effective treatment in randomized controlled clinical trials in comparison with usual clinic-based treatment [291], in addition to the efficacy of telephone-based cognitive behavioral therapy [292,293], confirming an earlier randomized controlled trial in depressed PD outpatients [294].…”

Section: Non-pharmacological Interventionsmentioning

confidence: 59%

“…The use of repetitive transcranial magnetic stimulation over the dorsolateral prefrontal cortex in PD depression could provide some, but modest, improvement [21,288]. Contrastingly, meta-analyses confirmed that electroconvulsive therapy had important beneficial effects for both motor symptoms and severe depression in PD [289,290].…”

Section: Non-pharmacological Interventionsmentioning

confidence: 99%

Depression in Patients with Parkinson’s Disease: Current Understanding of its Neurobiology and Implications for Treatment

et al. 2022

View full text Add to dashboard Cite

Depression is one of the most frequent and burdensome non-motor symptoms in Parkinson's disease (PD), across all stages. Even when its severity is mild, PD depression has a great impact on quality of life for these patients and their caregivers. Accordingly, accurate diagnosis, supported by validated scales, identification of risk factors, and recognition of motor and non-motor symptoms comorbid to depression are critical to understanding the neurobiology of depression, which in turn determines the effectiveness of dopaminergic drugs, antidepressants and non-pharmacological interventions. Recent advances using in vivo functional and structural imaging demonstrate that PD depression is underpinned by dysfunction of limbic networks and monoaminergic systems, depending on the stage of PD and its associated symptoms, including apathy, anxiety, rapid eye movement sleep behavior disorder (RBD), cognitive impairment and dementia. In particular, the evolution of serotonergic, noradrenergic, and dopaminergic dysfunction and abnormalities of limbic circuits across time, involving the anterior cingulate and orbitofrontal cortices, amygdala, thalamus and ventral striatum, help to delineate the variable expression of depression in patients with prodromal, early and advanced PD. Evidence is accumulating to support the use of dual serotonin and noradrenaline reuptake inhibitors (desipramine, nortriptyline, venlafaxine) in patients with PD and moderate to severe depression, while selective serotonin reuptake inhibitors, repetitive transcranial magnetic stimulation and cognitive behavioral therapy may also be considered. In all patients, recent findings advocate that optimization of dopamine replacement therapy and evaluation of deep brain stimulation of the subthalamic nucleus to improve motor symptoms represents an important first step, in addition to physical activity. Overall, this review indicates that increasing understanding of neurobiological changes help to implement a roadmap of tailored interventions for patients with PD and depression, depending on the stage and comorbid symptoms underlying PD subtypes and their prognosis.

show abstract

“…Owing to the limitations of pharmacological treatments, non-pharmacological treatments have been developed and have gradually gained popularity. Many non-pharmacological treatments have been used to relieve depressive symptoms in patients with PD, and these can be roughly categorized into complementary therapies (e.g., yoga, acupuncture, auricular pressure, massage, music therapy, and dance therapy), traditional Chinese exercises (e.g., tai chi and qigong), physical exercise (e.g., aerobic exercise, resistance exercise, and balance training), virtual reality, cognitive behavioral therapy (CBT), psychotherapy, cognitive training (CT), bright light therapy (BLT), deep brain stimulation (DBS), transcranial magnetic stimulation (TMS), and transcranial direct current stimulation (tDCS) (Jin et al, 2019;Zhang et al, 2019;Deuel and Seeberger, 2020;Triegaardt et al, 2020;Chen et al, 2021;Hong et al, 2021;Huang et al, 2021). Previous studies (Troeung et al, 2014;Ryan et al, 2019;Assogna et al, 2020) have paid more attention to the effects of CBT and TMS on depression in PD patients and indicated that these two therapies are supportive for improving depression.…”

Section: Introductionmentioning

confidence: 99%

Efficacy of non-pharmacological interventions for depression in individuals with Parkinson's disease: A systematic review and network meta-analysis

Wang

Sun

et al. 2022

Front. Aging Neurosci.

View full text Add to dashboard Cite

BackgroundDepression in Parkinson's disease (PD) is a major health concern worldwide. Recently, an increasing number of non-pharmacological interventions have been used in PD to alleviate depressive symptoms. However, it is uncertain which intervention is the best, and related evidence is limited. This network meta-analysis was performed to compare and rank non-pharmacological interventions for PD and analyze their effects on depression to provide evidence for clinicians to choose appropriate non-pharmacological management options.MethodsThe PubMed, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, China National Knowledge Infrastructure (CNKI), and Wanfang databases were searched from inception to April 7, 2022. Two authors screened all studies, extracted the data, and evaluated the methodological quality. STATA software version 16.0 was used to conduct the network meta-analysis.ResultsOur network meta-analysis included 62 studies involving 3,050 participants and 35 non-pharmacological interventions. Although most non-pharmacological interventions showed non-significant effects, the surface under the cumulative ranking curve (SUCRA) values indicated that the best non-pharmacological intervention for depression was dance (82.3%), followed by LSVT-BIG therapy (77.4%), and CBT (73.6%).ConclusionDance can be considered as an effective therapy for improving depression in patients with PD. In the future, more strictly designed trials are needed to verify the conclusions of this network meta-analysis.

show abstract

Non-pharmacological treatment for Parkinson disease patients with depression: a meta-analysis of repetitive transcranial magnetic stimulation and cognitive-behavioral treatment

Cited by 14 publications

References 30 publications

Low-Frequency Repetitive Transcranial Magnetic Stimulation over Right Dorsolateral Prefrontal Cortex in Parkinson’s Disease

Low-Frequency Repetitive Transcranial Magnetic Stimulation over Right Dorsolateral Prefrontal Cortex in Parkinson’s Disease

Depression in Patients with Parkinson’s Disease: Current Understanding of its Neurobiology and Implications for Treatment

Efficacy of non-pharmacological interventions for depression in individuals with Parkinson's disease: A systematic review and network meta-analysis

Contact Info

Product

Resources

About