Effects of dance therapy on non-motor symptoms in patients with Parkinson's disease: a systematic review and meta-analysis

An In-Person and Online Intervention for Parkinson Disease (UPGRADE-PD): Protocol for a Patient-Centered and Culturally Tailored 3-Arm Crossover Trial

BACKGROUND

Dance for Parkinson's Disease (DfPD) is a dance program for individuals with Parkinson disease (PD). There is a lack of knowledge about the effect of this program on frailty and sarcopenia experienced by patients with PD. In addition, no randomized controlled trial to date has investigated either the possible differential effects of in-person versus online DfPD or the possible effects of DfPD on clinical parameters in Greek patients with PD.

OBJECTIVE

We aimed to assess the efficacy, safety, and feasibility of a culturally tailored and patient-centered DfPD program offered both in-person and online to Greek patients with early- to midstage PD.

METHODS

This is a 3-arm crossover randomized controlled trial (in-person DfPD vs online DfPD vs control) of UPGRADE-PD (Upbeating Greek Application of Dance in Parkinson's Disease). The experimental period will be 10 months, including three 2-month interventional periods of two 60-minute dance classes per week for each group (in-person DfPD vs online DfPD) versus a control group (nonintervention group), and two 2-month washout periods between each group for 40 Greek patients with early- to midstage PD. Assessments will be performed face-to-face at baseline and at the end of each study period and will include quality of life, fatigue, depressive symptoms, stress, anxiety, sarcopenia, frailty, balance, cognitive functions, movement and nonmovement PD symptoms, and BMI. Safety, feasibility, and patient satisfaction for each dance intervention (in-person DfPD vs online DfPD) will be assessed as well.

RESULTS

The study protocol was approved by the Medical Ethics Committee of the Eginition University Hospital in September 2022 and the Research and Ethics Committee of the University of West Attica in October 2023 and funded in September 2023. The first participant was enrolled in April 2023, and the trial is currently ongoing and will conclude in September 2024.

CONCLUSIONS

The results of this study are expected to show the possible differential effect of a patient-centered and culturally tailored in-person vs online DfPD intervention on several movement and nonmovement symptoms, as well as on quality of life, sarcopenia, and frailty in people living with PD in Greece.

TRIAL REGISTRATION

ClinicalTrials.gov NCT06220084; https://clinicaltrials.gov/study/NCT06220084.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

DERR1-10.2196/65490.

Active group-based performing arts interventions in Parkinson's disease: an updated systematic review and meta-analysis

OBJECTIVES

To assess the evidence for active group-based performing arts interventions for people with Parkinson's disease (PD).

SETTING

Scholarly literature (published in English) from any country or countries (last search February 2025). This systematic review was not registered and received no funding.

DATA SOURCES

Five bibliographic databases: AMED (Ebsco), APA PsycINFO (Ovid), CINAHL (Ebsco), EMBASE (Ovid) and MEDLINE (Ovid), plus supplementary searches.

PRIMARY AND SECONDARY OUTCOME MEASURES

Eligible studies used a quantitative design to assess the benefit of active group-based performing arts interventions on quality of life, functional communication, speech, motor function and cognitive status in PD. The risk of bias was assessed using the SURE, University of York Centre for Reviews and Dissemination and Newcastle-Ottawa Scale checklists. Data were synthesised using narrative synthesis and random-effects meta-analysis.

RESULTS

A total of 94 studies were included: 2453 people with PD (mean age 68 years, 55% male) from 18 countries. Narrative synthesis supported nine combinations of performing arts modalities and outcome domains, including a benefit for dance on motor function (supported by 50 out of 54 studies), dance on quality of life (supported by 24 out of 37 studies) and singing on speech (supported by 17 out of 20 studies). Meta-analysis supported five combinations of performing art modalities, comparators and outcomes, including a clinically significant benefit for PD-specific dance versus usual care PDQ-39, MD -7.81, 95% CI -11.87 to -3.75 and tango-based dance versus usual care on UPDRS-III, MD -9.89, 95% CI -16.65 to -3.13.

CONCLUSIONS

Evidence from both the narrative synthesis and the meta-analysis supports a benefit for some combinations of performing arts modalities and outcomes. Limitations of the evidence base included differences in comparators and outcomes, heterogeneity, lack of control arms and male underrepresentation. Future studies should compare the effectiveness of different performing arts modalities, assess functional communication and consider clinical significance.

"You need to know that you are not alone": the sustainability of community-based dance programs for people living with Parkinson's disease

PURPOSE

To identify factors contributing to the long-term sustainability of community-based dance programs for people living with Parkinson's disease in order to inform the design and development of sustainable programs.

METHODS

Multi-site ethnographic fieldwork was conducted at four different preexisting dance programs for people living with Parkinson's disease. Dancer, facilitator, and community stakeholder perspectives were gathered via semi-structured interviews in order to create a deeper understanding of how existing programs navigate challenges and maintain stability. Transcripts and field notes were analyzed via reflexive thematic analysis.

RESULTS

Interviews were conducted with 18 participants (eight dancers with Parkinson's disease, seven dance facilitators, one classroom assistant, and two community stakeholders). Four key areas for supporting program sustainability were identified: (1) finding an organizational structure that works, (2) balancing funding, fundraisers, and fees, (3) prioritizing dancer experience and satisfaction, and (4) recruiting and retaining committed, high-quality facilitators.

CONCLUSION

Cultivating multiple funding sources; forging strategic connections with local Parkinson's organizations and arts institutions; building a critical mass of facilitators and administrators with diverse skillsets; offering hybrid online delivery where possible; and ensuring that the dancer experience is low-pressure, varied, and enjoyable can support the long-term sustainability of dance programs for people living with Parkinson's disease.

Quality assessment and umbrella review of systematic reviews about dance for people with Parkinson's disease

OBJECTIVE(S)

To determine (1) the quality of systematic reviews about dance-based intervention in individuals with Parkinson's disease (PD) and (2) standard evidence for dance-based intervention efficacy based on the categories of The International Classification of Functioning, Disability, and Health (ICF) from the World Health Organization's (WHO).

METHODS

The data source included MEDLINE, PUBMED, Embase, Scopus, CENTRAL (Cochrane Library), CINAHL, PEDro, SPORTDiscus, APA PsycNet (APA PsycINFO), LILACS, SciELO, and AMED. Pairs of independent reviewers screened titles, abstracts, and full texts of eligible studies by using the software Covidence. Criteria included: systematic review designs; individuals with PD; dance-based interventions aimed to change critical PD symptoms matched to IFC domains (body functions, activities, and participation). Independent reviewers extracted information regarding the characteristics of all systematic reviews included and appraised quality using A MeaSurement Tool to Assess Systematic Reviews (AMSTAR 2). Randomized controlled trials and their risk of bias were identified within each review and were used to perform an updated pairwise meta-analysis.

RESULTS

Of the 571 manuscripts screened, 55 reviews met the inclusion criteria. The overall confidence in the results of 38 reviews (69%) was rated as 'critically low,' nine (9%) as 'low,' one (2%) as 'moderate,' while seven of 55 reviews (13%) were rated as 'high'. Dance associated with pharmacological usual care is better than pharmacological usual care alone for essential components of ICF, such as motor symptoms severity (body function), depressive symptoms (body function), balance (body function and activity), and functional mobility (activity), but not for gait distance (activity) and quality of life (participation). Dance is also superior to multimodal exercise to improve balance.

CONCLUSIONS

Clinicians and people with PD can refer to this paper for a summary of high-quality reviews and the overall evidence supporting dance as an adjunct rehabilitation. This umbrella review not only underscores the therapeutic potential of dance but also reinforces the use of arts-based approaches into healthcare practices for people with neurological conditions.

German Society of Neurology guidelines for the diagnosis and treatment of cognitive impairment and affective disorders in people with Parkinson's disease: new spotlights on diagnostic procedures and non-pharmacological interventions

BACKGROUND AND OBJECTIVE

Cognitive impairment and dementia as well as affective disorders are common and debilitating syndromes that develop in people with Parkinson's disease (PwPD). The authors summarized recommendations for the 2023 updated German guidelines on "Parkinson's disease" from the German Neurological Society (DGN), focusing on the diagnosis and treatment of these disorders.

METHODS

The recommendations were based on literature reviews, other relevant guidelines, and expert opinions.

RESULTS

Measurements to assess cognitive and affective states were reviewed for psychometric properties, use in routine clinical practice, and availability in German. To improve mild cognitive impairment, cognitive training and physical aerobic training are recommended. To treat Parkinson's disease (PD)-related dementia, cognitive stimulation (as a non-pharmacological intervention) and acetylcholinesterase inhibitors (AChEIs, i.e., rivastigmine) are recommended. Cognitive behavioral therapy is recommended to treat depression, anxiety, and fear of progression. Physical interventions are recommended to treat depression, fatigue, and apathy. Optimized dopaminergic treatment is the first-line pharmacological strategy recommended to manage depression, apathy, anhedonia, fatigue, and mood swings. Major depression can be additionally treated using venlafaxine or desipramine, while moderate depression can be treated pharmacologically according to its clinical phenotype (psychomotor retardation or agitation) and comorbidities (e.g., sleep disturbances, pain). Venlafaxine and nortriptyline can be used to treat anhedonia, while citalopram can be used for anxiety.

CONCLUSIONS

In addition to the updated pharmacological treatment options, new insights into recommendations for standardized diagnostics and non-pharmacological interventions were provided for the German health care system. However, more studies are needed to explore the full potential of non-pharmacological interventions to treat and prevent cognitive impairment and affective disorders.

Physical Exercise for Treating the Anxiety and Depression Symptoms of Parkinson's Disease: Systematic Review and Meta-Analysis

BACKGROUND

Depression and anxiety are non-motor symptoms of Parkinson's disease (PD). Physical exercise is a promising approach to reducing neuropsychological burden. We aimed to comprehensively synthesize evidence regarding the use of exercise for treating depression and anxiety symptoms in PD.

METHODS

Systematic review and meta-analysis following PRISMA recommendations. Searches on PubMed, Cochrane Library, Scopus, Web of Science, Embase, and Physiotherapy Evidence Database (PEDro) was conducted. The random-effects model was employed for all analyses with the standardized mean difference as the effect estimate.

RESULTS

Fifty records were retrieved, but only 17 studies met the criteria for the meta-analyses. A moderate to large effect was observed for depression (-.71 [95% CI = -.96 to -.46], 11 studies, 728 individuals), and a small to moderate effect for anxiety (-.39 [95% CI = -.65 to -.14], 6 studies, 241 individuals), when comparing exercise to non-exercise controls. Subgroup analysis revealed significant effects from aerobic (-.95 [95% CI = -1.60, -.31]), mind-body (-1.85 [95% CI = -2.63, -1.07]), and resistance modalities (-1.61 [95% CI = -2.40, -.83]) for depression, and from mind-body (-.67 [95% CI = -1.19 to -.15]) and resistance exercises (-1.00 [95% CI = -1.70 to -.30]) for anxiety.

CONCLUSION

Physical exercise has a relevant clinical impact on depression and anxiety in PD. We discuss the level of the evidence, the methodological limitations of the studies, and give recommendations.

The importance of dance for the cognitive function of people with Parkinson's: A systematic review with meta-analysis

OBJECTIVE

Investigate the effectiveness of dance intervention to provide evidence of its effects on cognition in people with Parkinson's.

METHODS

A study registered in PROSPERO (CRD42023474696), with searches carried out electronically in five databases (PubMed Central®, Embase, Web of Science, ScienceDirect, and Scopus Elsevier), over the last 10 years. The risk of bias was assessed using the Cochrane collaboration scale (RoB2 and ROBINS-I).

RESULTS

The studies presented ''low'' and ''moderate'' risks of bias. The instruments to assess cognitive function were heterogeneous. The dance modalities used were named dance training, dance-physiotherapy, Brazilian samba, dance, Sardinian folk dance, dance therapy, and tango. Eleven studies were included in the review and the meta-analysis showed high heterogeneity (I2 = 90%; p < 0.0001). The analysis with 6 studies that used the same cognitive screening instrument (MoCA) showed low heterogeneity (I2 = 0%; p = 0.41). The funnel plot presents the studies in a dispersed manner, which suggests publication bias.

The effects of mind-body exercise on anxiety and depression in older adults: a systematic review and network meta-analysis

Background

Limited research directly compares the clinical effects of different types of mind-body exercises on anxiety and depression in older adults. Therefore, we conducted a systematic review and network meta-analysis of randomized controlled trials that meet the inclusion criteria to explore the intervention effects of five different types of mind-body exercises in improving anxiety and depression in older adults.

Methods

We followed the PRISMA-NMA guidelines and conducted searches in the Web of Science, PubMed, the Cochrane Library, and Embase databases up to July 28, 2023. The language was limited to English. Two independent reviewers conducted literature screening and data extraction. Review Manager 5.4 was used to perform Pairwise meta-analysis and risk assessment, while STATA version 15 software was used for network meta-analysis.

Result

A total of 42 studies, involving 2974 participants, were included. The results of the traditional meta-analysis showed that mind-body exercises were superior to the control group in alleviating anxiety (SMD: -0.87, 95% CI: -1.43, -0.31, p<0.05, I2 = 95%) and depressive (SMD: -0.52, 95% CI: -0.71, -0.34, p<0.05, I2 = 80%). In the network meta-analysis, the ranking of treatment effects for anxiety showed that Tai Chi > Qigong > Yoga > Dance > control group, while for depression, the ranking showed Tai Chi > Pilates > Yoga > Qigong > Dance > control group.

Conclusion

This study found that mind-body exercises have positive effects on improving anxiety and depression in older adults. Among the five different types of mind-body exercise interventions, Tai Chi was considered an effective approach for improving anxiety and depression. However, we encourage older adults to choose exercise modalities that suit their interests to enhance adherence.

Systematic review registration

http://www.crd.york.ac.uk/PROSPERO/, identifier CRD42023464296.

Effects of physical exercise interventions on balance, postural stability and general mobility in Parkinson's disease: a network meta-analysis

OBJECTIVE

To assess which type of physical exercise intervention has the most beneficial effects on balance, postural stability and general mobility in patients with Parkinson's disease. These parameters were assessed using the Activities-specific Balance Confidence (ABC) scale, Berg Balance Scale (BBS), Mini-Balance Evaluation Systems Test (MiniBESTest) and Timed Up and Go Test (TUG).

DESIGN

Network meta-analysis.

METHODS

The PubMed, Cochrane Central Register of Controlled Trials, and Web of Science databases were searched up to August 2022 to identify randomized controlled trials on the effects of physical exercise interventions on balance, postural stability, and general mobility. The network meta-analysis included pairwise and indirect comparisons of results on the ABC scale, BBS, MiniBESTest, and TUG across 8 categories of physical exercise.

RESULTS

Eighty-six studies with a total of 4,693 patients were included. For the ABC scale, the indirect comparison showed that the highest effect size was observed for balance vs sensorimotor training without including endurance interventions (0.62; 95% confidence interval (95% CI) 0.06, 1.17). The highest effect sizes for BBS were observed for alternative exercises (1.21; 95% CI 0.62, 1.81), body-weight supported (BWS) interventions (1.31; 95% CI 0.57, 2.05), dance (1.18; 95% CI 0.33, 2.03) and sensorimotor training, including endurance interventions (1.10; 95% CI 0.46, 1.75) vs control groups. Indirect comparisons showed that the highest effect size for the MiniBESTest were observed for balance (0.75; 95% CI 0.46, 1.04) and resistance (0.58; 95% CI 0.10, 1.07) vs control groups. For the TUG, comparisons showed a significant effect size for alternative exercises (-0.54; 95% CI -0.82, -0.26), balance (-0.42; 95% CI -0.75, -0.08), resistance (-0.60; 95% CI -0.89, -0.31), and sensorimotor training including endurance interventions (-0.61; 95% CI -0.95, -0.27) vs control comparisons.

CONCLUSION

Balance interventions improve balance, postural stability, and general mobility in people with Parkinson's disease. Moreover, alternative exercises, dance, BWS interventions, resistance, and sensorimotor training, including and not including endurance interventions, are also effective.

If Art Were a Drug: Implications for Parkinson's Disease

Parkinson's disease (PD) is a chronic and complex neurodegenerative disorder. Conventional pharmacological or surgical therapies alone are often insufficient at adequately alleviating disability. Moreover, there is an increasing shift toward person-centered care, emphasizing the concept of "living well". In this context, arts-based interventions offer great promise, functioning as platforms for creative expression that could provide novel mechanisms to promote quality of life. Here we present a qualitative review of arts-based interventions for PD, including music, dance, drama, visual arts, and creative writing. For each, we discuss their applications to PD, proposed mechanisms, evidence from prior studies, and upcoming research. We also provide examples of community-based projects. Studies to date have had relatively small sample sizes, but their findings suggest that arts-based interventions have the potential to reduce motor and non-motor symptoms. They may also empower people with PD and thereby address issues of self-esteem, foster personal problem-solving, and augment holistic well-being. However, there is a paucity of research determining optimal dosage and symptom-specific benefits of these therapies. If art were a drug, we would have to perform appropriately powered studies to provide these data before incorporating it into routine patient care. We therefore call for further research with properly designed studies to offer more rigorous and evidence-based support for what we intuitively think is a highly promising approach to support individuals living with PD. Given the possible positive impact on people's lives, arts-based approaches merit further development and, if proven to be effective, systematic inclusion within integrated management plans.

Alleviating Stress in Parkinson's Disease: Symptomatic Treatment, Disease Modification, or Both?

Psychological stress, a state of mental strain caused by mentally or physically threatening situations, plays a significant role in Parkinson's disease (PD). Motor symptoms worsen during acute stress and common non-motor symptoms in PD, such as anxiety and depression, are linked to chronic stress. Although evidence in humans is lacking, animal models of PD suggest that chronic stress can accelerate dopaminergic cell death. This suggests that stress-reducing interventions have not only symptomatic, but perhaps also disease-modifying effects. Our objective was to identify the most promising strategies for stress-reduction in PD and to analyze their potential value for disease-modification. An unstructured literature search was performed, primarily focusing on papers published between 2020-2023. Several large clinical trials have tested the efficacy of aerobic exercise and mindfulness-based interventions on PD symptoms. The evidence is promising, but not definitive yet: some exercise trials found a reduction in stress-related symptoms, whereas others did not or did not report it. In the majority of trials, biological measures of stress and of disease progression are missing. Furthermore, follow-up periods were generally too short to measure disease-modifying effects. Hence, mechanisms underlying the intervention effects remain largely unclear. These effects may consist of attenuating progressive neurodegeneration (measured with MRI-markers of substantia nigra integrity or cortical thickness), or a strengthening of compensatory cerebral mechanisms (measured with functional neuroimaging), or both. Lifestyle interventions are effective for alleviating stress-related symptoms in PD. They hold potential for exerting disease-modifying effects, but new evidence in humans is necessary to fulfill that promise.

Pharmacological and Non-Pharmacological Treatments for Depression in Parkinson's Disease: An Updated Review

Depression represents one of the most common non-motor disorders in Parkinson's disease (PD) and it has been related to worse life quality, higher levels of disability, and cognitive impairment, thereby majorly affecting not only the patients but also their caregivers. Available pharmacological therapeutic options for depression in PD mainly include selective serotonin reuptake inhibitors, serotonin and norepinephrine reuptake inhibitors, and tricyclic antidepressants; meanwhile, agents acting on dopaminergic pathways used for motor symptoms, such as levodopa, dopaminergic agonists, and monoamine oxidase B (MAO-B) inhibitors, may also provide beneficial antidepressant effects. Recently, there is a growing interest in non-pharmacological interventions, including cognitive behavioral therapy; physical exercise, including dance and mind-body exercises, such as yoga, tai chi, and qigong; acupuncture; therapeutic massage; music therapy; active therapy; repetitive transcranial magnetic stimulation (rTMS); and electroconvulsive therapy (ECT) for refractory cases. However, the optimal treatment approach for PD depression is uncertain, its management may be challenging, and definite guidelines are also lacking. It is still unclear which of these interventions is the most appropriate and for which PD stage under which circumstances. Herein, we aim to provide an updated comprehensive review of both pharmacological and non-pharmacological treatments for depression in PD, focusing on recent clinical trials, systematic reviews, and meta-analyses. Finally, we discuss the pharmacological agents that are currently under investigation at a clinical level, as well as future approaches based on the pathophysiological mechanisms underlying the onset of depression in PD.

Nicotinic acetylcholine receptors and learning and memory deficits in Neuroinflammatory diseases

Animal survival depends on cognitive abilities such as learning and memory to adapt to environmental changes. Memory functions require an enhanced activity and connectivity of a particular arrangement of engram neurons, supported by the concerted action of neurons, glia, and vascular cells. The deterioration of the cholinergic system is a common occurrence in neurological conditions exacerbated by aging such as traumatic brain injury (TBI), posttraumatic stress disorder (PTSD), Alzheimer's disease (AD), and Parkinson's disease (PD). Cotinine is a cholinergic modulator with neuroprotective, antidepressant, anti-inflammatory, antioxidant, and memory-enhancing effects. Current evidence suggests Cotinine's beneficial effects on cognition results from the positive modulation of the α7-nicotinic acetylcholine receptors (nAChRs) and the inhibition of the toll-like receptors (TLRs). The α7nAChR affects brain functions by modulating the function of neurons, glia, endothelial, immune, and dendritic cells and regulates inhibitory and excitatory neurotransmission throughout the GABA interneurons. In addition, Cotinine acting on the α7 nAChRs and TLR reduces neuroinflammation by inhibiting the release of pro-inflammatory cytokines by the immune cells. Also, α7nAChRs stimulate signaling pathways supporting structural, biochemical, electrochemical, and cellular changes in the Central nervous system during the cognitive processes, including Neurogenesis. Here, the mechanisms of memory formation as well as potential mechanisms of action of Cotinine on memory preservation in aging and neurological diseases are discussed.

Physical Exercise as a Potential Treatment for Fatigue in Parkinson's Disease? A Systematic Review and Meta-Analysis of Pharmacological and Non-Pharmacological Interventions

BACKGROUND

Fatigue is one of the most common and debilitating non-motor symptoms among patients with Parkinson's disease (PD) and significantly impacts quality of life. Therefore, effective treatment options are needed.

OBJECTIVE

To provide an update on randomized controlled trials (RCTs) including pharmacological and non-pharmacological (but non-surgical) treatments that examine the effects of fatigue on PD patients.

METHODS

We searched the MEDLINE, EMBASE, PsycINFO, CENTRAL, and CINAHL databases for (cross-over) RCTs on pharmacological and non-pharmacological interventions for treating fatigue in PD patients until May 2021. Meta-analyses for random-effects models were calculated when two or more studies on the same treatment option were available using standardized mean differences (SMDs) with 95% confidence intervals (CIs).

RESULTS

Fourteen pharmacological and 16 non-pharmacological intervention RCTs were identified. For pharmacological approaches, a meta-analysis could only be performed for modafinil compared to placebo (n = 2) revealing a non-significant effect on fatigue (SMD = - 0.21, 95% CI - 0.74-0.31, p = 0.43). Regarding non-pharmacological approaches, physical exercise (n = 8) following different training approaches versus passive or placebo control groups showed a small significant effect (SMD = - 0.37, 95% CI - 0.69- - 0.05, p = 0.02) which could not be demonstrated for acupuncture vs. sham-acupuncture (SMD = 0.16, 95% CI - 0.19-0.50, p = 0.37).

CONCLUSION

Physical exercise may be a promising strategy to treat fatigue in PD patients. Further research is required to examine the efficacy of this treatment strategy and further interventions. Future studies should differentiate treatment effects on physical and mental fatigue as the different underlying mechanisms of these symptoms may lead to different treatment responses. More effort is required to develop, evaluate, and implement holistic fatigue management strategies for PD patients.

Benefits of dance for Parkinson's: The music, the moves, and the company

Dance classes designed for people with Parkinson's are very popular and associated not only with increasing individuals' motor control abilities but also their mood; not least by providing a social network and the enjoyment of the music. However, quantitative evidence of the benefits is inconsistent and often lacks in power. For a better understanding of the contradictory findings between participants' felt experiences and existing quantitative findings in response to dance classes, we employed a mixed method approach that focussed on the effects of music. Participant experience of the dance class was explored by means of semi-structured interviews and gait changes were measured in a within-subjects design through the Timed Up and Go (TUG) test before and after class, with and without music. We chose the TUG test for its ecological validity, as it is a simple test that resembles movements done in class. We hypothesised that the music and the dance class would have a facilitating effect on the TUG performance. In line with existing research, we found that before class, the gait of 26 participants was significantly improved when accompanied by a soundtrack. However, after class, music did not have a significantly facilitating effect, yet gait without music significantly improved after class compared to before. We suggest that whilst the music acts as an external stimulator for movement before the dance class, after the dance class, participants have an internalised music or rhythm that supports their motor control. Thus, externally played music is of less relevance. The importance of music was further emphasised in the qualitative data alongside social themes. A better understanding of how music and dance affects Parkinson's symptoms and what aspects make individuals 'feel better' will help in the design of future interventions.

Moving online: Experiences and potential benefits of digital dance for older adults and people with Parkinson's disease

BACKGROUND

Dance provides a range of beneficial effects for older adults including individuals with age-related neurological conditions such as Parkinson's disease (PD). The COVID-19 pandemic accelerated the development of at-home dance programs delivered digitally through live and pre-recorded media, but little is known about how participants may engage with and benefit from these resources.

OBJECTIVE

This study explored experiences and potential benefits of digital dance participation among healthy older adults and people with PD.

METHODS

An online survey consisting of fixed-choice and open questions was designed in collaboration with dance program providers and distributed between June and November 2020.

RESULTS

Healthy older adults (N = 149) and people with PD (N = 178) participating in at-home dance programs reported frequent engagement and a range of benefits. People with PD reported greater levels of motor (e.g., ease of movement, balance) than non-motor (e.g., energy, confidence) outcomes, while healthy older adults reported similar numbers of motor and non-motor outcomes. Positive outcomes were associated with the use of movement imagery during dance in both groups, while singing was associated with benefits in people with PD and vocalising was associated with benefits in older adults. At-home dance resources were found to offer convenience and flexibility, but participants missed the interaction, support, and routine provided by in-person classes. The majority expressed a preference to continue with both digital and in-person participation in the future. Qualitative analysis of participants' comments further revealed that digital participation could help to maintain connection and well-being, as well as identifying further considerations for improving accessibility and facilitating digital engagement.

CONCLUSIONS

At-home dance appears to be accessible, engaging, and potentially beneficial for older adults and people with PD, although barriers to participation should be addressed. Digital resources will be increasingly important to enable cost-effective, large-scale provision of home-based therapeutic activities.

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

BACKGROUND

Depression 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.

METHODS

The 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.

RESULTS

Our 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%).

CONCLUSION

Dance 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.

Management of psychiatric and cognitive complications in Parkinson's disease

Neuropsychiatric symptoms (NPSs) such as affective disorders, psychosis, behavioral changes, and cognitive impairment are common in Parkinson's disease (PD). However, NPSs remain under-recognized and under-treated, often leading to adverse outcomes. Their epidemiology, presentation, risk factors, neural substrate, and management strategies are incompletely understood. While psychological and psychosocial factors may contribute, hallmark PD neuropathophysiological changes, plus the associations between exposure to dopaminergic medications and occurrence of some symptoms, suggest a neurobiological basis for many NPSs. A range of psychotropic medications, psychotherapeutic techniques, stimulation therapies, and other non-pharmacological treatments have been studied, are used clinically, and are beneficial for managing NPSs in PD. Appropriate management of NPSs is critical for comprehensive PD care, from recognizing their presentations and timing throughout the disease course, to the incorporation of different therapeutic strategies (ie, pharmacological and non-pharmacological) that utilize a multidisciplinary approach.

Apathy in Parkinson's Disease: Defining the Park Apathy Subtype

Apathy is a neurobehavioural symptom affecting Parkinson's disease patients of all disease stages. Apathy seems to be associated with a specific underlying non-motor disease subtype and reflects dysfunction of separate neural networks with distinct neurotransmitter systems. Due to the complicated neuropsychiatric aetiology of apathy, clinical assessment of this invalidating non-motor symptom remains challenging. We aim to summarize the current findings on apathy in Parkinson's disease and highlight knowledge gaps. We will discuss the prevalence rates across the different disease stages and suggest screening tools for clinically relevant apathetic symptoms. We will approach the fundamental knowledge on the neural networks implicated in apathy in a practical manner and formulate recommendations on patient-tailored treatment. We will discuss the Park apathy phenotype in detail, shedding light on different clinical manifestations and implications for prognosis. With this review, we strive to distil the vast available theoretical knowledge into a clinical and patient-oriented perspective.

Effect of Physical Activity on Depression in Patients with Parkinson's Disease: A Systematic Review and Meta-Analysis

Parkinson’s disease (PD) is the second most common neurodegenerative disease worldwide, and approximately 50% of PD patients suffer from depression. We aim to determine the effects of physical activity on depression in PD patients and to provide scientific evidence-based exercise prescriptions for PD patients. A systematic review was conducted by searching PubMed, Embase, Cochrane Library, and PsycInfo until February 2022 for randomized controlled trial (RCT) studies published in English. The primary outcome was a score on a depression scale. A total of 14 RCTs involving 516 patients with PD were included in this study. The results of the meta-analysis showed that physical activity had a moderate and significant improvement in depression in PD patients (SMD = −0.60; 95% CI = −0.79 to −0.41; p < 0.00001). Subgroup analysis indicated that resistance exercise for 60−90 min more than 4 times per week for up to 12 weeks had a significant effect on PD patients who have had the disease for more than 5 years. Meta-regression showed that intervention type, intervention time, intervention frequency, intervention period, age, and disease duration were not sources of heterogeneity. Physical activity may reduce depression in PD patients. However, other larger sample sizes and high-quality studies are needed to validate these effects in the future.