Prioritising target non-pharmacological interventions for research in Parkinson’s disease: achieving consensus from key stakeholders

Abstract

Background: In 2014 Parkinson's UK conducted a research prioritisation exercise with stakeholders highlighting important clinical research questions. The exercise highlighted the need for effective interventions to be developed and tested to tackle a range of non-motor symptoms including: sleep quality, stress and anxiety, mild cognitive impairment, dementia and urinary problems. The present work set out to build on this exercise by prioritising types of non-pharmacological interventions to be tested to treat the identified non-motor symptoms. Methods: A Patient and Public Involvement exercise was used to reach consensus on intervention priorities for the treatment of non-motor symptoms. A Delphi structure was used to support the feedback collected. A first-round prioritisation survey was conducted followed by a panel discussion. Nineteen panellists completed the first-round survey (9 people with Parkinson's and 10 professionals working in Parkinson's) and 16 participated in the panel discussion (8 people with Parkinson's and 8 professionals working in Parkinson's). A second-round prioritization survey was conducted after the panel discussion with 13 people with Parkinson's. Results: Physical activity, third wave cognitive therapies and cognitive training were rated as priority interventions for the treatment of a range of non-motor symptoms. There was broad agreement on intervention priorities between health care professionals and people with Parkinson's. A consensus was reached that research should focus on therapies which could be used to treat several different non-motor symptoms. In the context of increasing digitisation, the need for human interaction as an intervention component was highlighted. Conclusion: Bringing together Parkinson's professionals and people with Parkinson's resulted in a final treatment priority list which should be both feasible to carry out in routine clinical practice and acceptable to both professionals and people with Parkinson's. The workshop further specified research priorities in Parkinson's disease based on the current evidence base, stakeholder preferences, and feasibility. Research should focus on developing and testing non-pharmacological treatments which could be effective across a range of symptoms but specifically focusing on tailored physical activity interventions, cognitive therapies and cognitive training.

Experiences of People Living with Parkinson’s Disease in Care Homes: A Qualitative Systematic Review

“…These interventions include physical activity programs tailored to the needs of PD patients, such as specific exercises targeting mobility and balance. Additionally, cognitive skills training has demonstrated effectiveness in addressing cognitive impairments often associated with PD, providing residents with strategies to enhance memory and executive function [40]. Psychological therapies such as mindfulness, cognitive behavioural therapy (CBT) and stress management techniques offer avenues for managing emotional and psychological symptoms commonly experienced by individuals with PD [40].…”

“…Additionally, cognitive skills training has demonstrated effectiveness in addressing cognitive impairments often associated with PD, providing residents with strategies to enhance memory and executive function [40]. Psychological therapies such as mindfulness, cognitive behavioural therapy (CBT) and stress management techniques offer avenues for managing emotional and psychological symptoms commonly experienced by individuals with PD [40]. Incorporating these interventions into care home routines can contribute to enhancing the overall quality of life for residents with Parkinson's disease.…”

Liposome-Derived Nanosystems for the Treatment of Behavioral and Neurodegenerative Diseases: The Promise of Niosomes, Transfersomes, and Ethosomes for Increased Brain Drug Bioavailability

“…Dopamine agonists are also used, with ergot dopamine agonists mainly acting on D2, D3, and D4 receptors (e.g., cabergoline, bromocriptine, and pergolide), and with non-ergot dopamine agonists acting more selectively on D2 or D3 receptors (e.g., ropinirole and pramipexole), with anticholinergics (e.g., benzhexol, orphenadrine, and benztropine), catechol-O-methyltransferase inhibitors (e.g., entacapone, tolcapone, or opicapone), monoamine oxidase-B inhibitors (e.g., selegiline and rasagiline), and amantadine (N-methyl-D-aspartate-glutamate and cholinergic muscarinic receptor inhibitors) also being commonly prescribed [54][55][56]. Non-pharmacological treatments, such as physical exercise and physiotherapy (involving endurance, balance, strength, and coordination), along with cognitive training (memory and logical thinking), are also required in order to slow down the disease's progression [57,58]. Nevertheless, again, these treatments can only be effective in treating the symptoms associated with Parkinson's disease, and therapies that can slow down its progression or even cure it are still lacking [49,51,52].…”

Principal Component Analysis Enhanced with Bootstrapped Confidence Interval for the Classification of Parkinsonian Patients Using Gaussian Mixture Model and Gait Initiation Parameters

“…The heterogeneity of PD symptoms involves the fact that patients are taken in charge through a multidisciplinary team approach combining complementary treatments [ 1 ], typically pharmacological (Levodopa intake being the “first line” of medication [ 6 ]), neurosurgical (e.g., deep brain stimulation [ 7 ]), or non-pharmacological rehabilitation treatments [ 8 , 9 , 10 ]. However, as stressed in the literature, there is currently a need to provide new non-pharmaceutical protocols to classify the progression of the disease and evaluate the efficiency of these treatments [ 11 ].…”