Tai Chi improves non-motor symptoms of Parkinson's disease: One-year randomized controlled study with the investigation of mechanisms

Effects of Acoustically Screened Five-Element Music Combined with Traditional Chinese Mind-Body Exercises on Emotion Regulation, Working Memory, and Functional Brain Connectivity in Older Adults: A Randomized Repeated-Measures Study

This study aimed to investigate the effects of acoustically screened Five-Element Music combined with traditional Chinese mind-body exercises (Taijiquan and Baduanjin) on emotion regulation, working memory, and functional brain connectivity in older adults. A randomized repeated-measures design was employed, recruiting 42 healthy older adults aged 60-70 years. Participants were assigned to five groups: Five-Element Music alone (FE), Taijiquan (TJ), Baduanjin (BDJ), Five-Element Music combined with Taijiquan (FE+TJ), and Five-Element Music combined with Baduanjin (FE+BDJ). Emotion regulation, working memory, and functional brain connectivity were assessed using an emotion regulation choice task, the N-back task, and functional near-infrared spectroscopy (fNIRS), respectively. Five-Element Music was selected using computational acoustic methods to identify music with therapeutic effects. Significant differences were observed in the acceptance rate of emotion regulation for high-intensity unpleasant pictures across different conditions (p = 0.001). Compared to baseline, the acceptance rate was significantly higher in the FE and FE+TJ conditions (p = 0.027, p = 0.021). Moreover, the acceptance rate in the FE+TJ condition was significantly higher than in the FE condition alone (p = 0.007). Significant differences were found in the average accuracy of the 2-back task across conditions (p = 0.001), with the FE+TJ condition showing significantly higher accuracy than baseline (p = 0.005). The average reaction time in the 2-back task also differed significantly across conditions (p = 0.001), with the FE condition demonstrating a significantly lower reaction time compared to baseline and the FE+BDJ condition (p = 0.003, p = 0.001). Significant differences in functional connectivity (FC) were observed between conditions. Specifically, the FC between CH45 and CH9 and between CH29 and CH6 was significantly higher in the FE+TJ condition than in other conditions (p < 0.02). The combination of Five-Element Music and Taijiquan significantly improved emotion regulation, working memory, and prefrontal-parietal connectivity in older adults. These findings underscore the synergistic benefits of integrating auditory stimulation with mind-body exercise, offering a promising intervention for cognitive and emotional health in aging populations. Future research should investigate long-term effects and broader applications.

Traditional Chinese exercises for the treatment of neuropsychiatric symptoms in Parkinson's disease: A systematic review and meta-analysis

OBJECTIVE

To systematically evaluate the efficacy of traditional Chinese exercises (TCEs) for neuropsychiatric symptoms (NPSs) in patients with Parkinson's disease.

METHODS

A comprehensive literature search was performed across eight databases, including PubMed, Cochrane Library, Embase, Web of Science (WoS), SinoMed, China National Knowledge Infrastructure (CNKI), China Science and Technology Periodical Database (VIP), and Wanfang Database, covering studies published from their inception up to April 23, 2024. The search focused on identifying randomized controlled trials (RCTs) assessing the effectiveness of TCEs for NPSs in PD patients. The authors independently performed literature screening and data extraction. Meta-analysis was executed employing Review Manager V.5.3 software, and Stata 17.0 was used to detect publication bias and perform sensitivity analysis. GRADEpro GDT was used to grade the certainty of each outcome evidence.

RESULTS

Eighteen studies involving 937 participants were included. The meta-analysis showed significant improvements in depression-related scales (standardized mean difference (SMD) = -1.30, 95 % confidence interval (CI): -2.10 to -0.49, p = 0.002), anxiety-related scales (SMD = -1.11, 95 %CI: -2.14 to -0.08, p = 0.03), sleep disorder-related scales (SMD = -0.71, 95 %CI: -0.99 to -0.43, p < 0.00001), and cognition-related scales (SMD = 0.91, 95 %CI: 0.44-1.38, p = 0.0001). Quality of life also improved (SMD = -1.35, 95 % CI: -2.38 to -0.31, p = 0.01; SMD = 0.99, 95 % CI: 0.54-1.43, p < 0.0001). Subgroup analyses grounded in the duration of the intervention suggested that interventions lasting up to 12 weeks showed more significant anti-depression and anti-anxiety effects while those lasting beyond 12 weeks demonstrated greater improvements in sleep quality and cognitive function. Additionally, subgroup analyses based on the type of intervention revealed that both using TCEs alone and the combination of TCEs with conventional medications showed greater effects on anti-depression and cognitive function, while the latter yield more significant anti-anxiety effects. However, no statistical significance was found for fatigue-related scales. The clinical trials included in this review also lacked a thorough description of the randomization process, and only a small proportion reported adequate allocation concealment procedures, raising concerns about potential selection bias. Moreover, owing to the inherent characteristics of TCEs, blinding both participants and practitioners is challenging, which may result in performance bias. Additionally, the absence of blinding could allow assessors' subjective influences to affect the outcomes, leading to detection bias. The overall quality of the evidence, as assessed according to the GRADE criteria, was rated as very low or low for most of outcomes.

CONCLUSIONS

The findings indicated that the use of TCEs may have potential to alleviate the severity of NPSs including depression, anxiety, sleep disorders, and enhance cognition function and overall quality of life in PD patients. Nevertheless, given the limited number of studies and their methodologic issues such as the absence of blinding, along with the small sample sizes, significant heterogeneity across these primary studies, careful interpretation of the results is warranted. More high-quality research with larger sample sizes, including double-blind studies or those employing an active control group involving exercises such as walking, ought to be carried out to validate the above findings and strengthen the evidence base.

REGISTRATION

PROSPERO: CRD42024540164.

Effects of Tai Chi on executive function, single-leg dynamic balance, and brain functional connectivity in older adults

Although previous studies have confirmed the beneficial effects of Tai Chi Chuan (TCC) on improving balance ability and cognitive function in older adults, the synergistic regulatory mechanisms of TCC on bilateral lower limb muscle activation symmetry, brain functional connectivity(FC) strength, and dynamic balance ability remain unclear. This study aims to investigate the effects of a 9-week TCC training program on the executive function (EF), bilateral lower limb muscle activation symmetry, single-leg dynamic balance ability, and brain FC strength in elderly individuals. It provides valuable new insights into a field that has not been extensively explored before. After 9-week training intervention, (1) The TCC group showed significant improvements in the Y-balance Test (YBTs), with enhanced symmetry in single-leg dynamic balance between the bilateral lower limbs and a significant reduction in the laterality of lower limb muscle activation. (2) TCC training strengthened the FC of related brain regions during YBTs. When performing YBTs with the left and right legs separately, the laterality of the average brain FC strength between the two tasks was significantly reduced. (3) During EF tasks, the reaction time was significantly reduced, and the concentration of oxygenated hemoglobin in the prefrontal cortex increased. Studies have shown that TCC has significantly superior intervention effects compared to brisk walking in improving neuromuscular function in older adults. Through its multisensory integration training model, TCC simultaneously enhances neuromuscular coordination and brain network collaboration efficiency, promoting the adaptive reorganization of dynamic balance control.

Targeting neuroplasticity: a viewpoint on a future research direction with Parkinson's disease-related fatigue

Parkinson's disease-related fatigue has an insidious onset and complex pathomechanisms, causing many adverse effects on patients. In clinical practice, Parkinson's disease-related fatigue has not received sufficient attention, and its early diagnosis and targeted interventions are inadequate. Currently, pharmacological treatments for Parkinson's disease-related fatigue have limited efficacy and nonpharmacological therapies such as non-invasive brain stimulation techniques and exercise therapy have been shown to have a role in improving Parkinson's disease-related fatigue. Further studies have revealed that modulation of functional cortical excitability, induction of neuroplasticity changes, inhibition of oxidative stress, improvement of cardiorespiratory fitness, and enhancement of muscle strength may be potential mechanisms of action of non-pharmacological therapies. As relevant research continues to progress, targeted therapy based on the theory of neuroplasticity may become an important therapeutic idea for Parkinson's disease-related fatigue. This article provides an overview of the diagnosis, etiology, and treatment of Parkinson's disease-related fatigue, and on this basis proposes a new diagnostic and therapeutic idea of targeting neuroplasticity to improve Parkinson's disease-related fatigue for clinical reference. Further studies on the pathological mechanisms of Parkinson's disease-related fatigue are needed in the future to optimize the treatment regimen of Parkinson's disease-related fatigue to improve the efficacy of treatment for the benefit of patients.

Effects of Different Traditional Chinese Mind-Body Exercises on Learning Abilities, Executive Functions, and Brain Connectivity in Children with Learning Difficulties

This study examines the effects of three traditional Chinese mind-body exercises-Tai Chi (TC), Baduanjin (BD), and Health Qigong Yijinjing (YJJ)-on learning abilities, executive functions, and prefrontal brain connectivity in children with learning difficulties. Seventy-two children (aged 9-11) with learning difficulties were randomly assigned to TC, BD, YJJ, or a control group (CON). Intervention groups practiced for 12 weeks (45 min, three times per week), while the control group maintained their regular physical education. Assessments included Academic Performance Ranking (APR), Pupil Rating Scale (PRS), and executive functions. Granger causality analyses were conducted on the functional near-infrared spectroscopy data to derive the effective connectivity at the brain region levels. Post-intervention, all intervention groups showed significant improvements over the control group in PRS and APR scores (p < 0.05), with the TC group achieving higher PRS scores than the BD group. The TC group also demonstrated superior improvements in executive functions, particularly in inhibition and working memory. Additionally, the TC group exhibited significantly enhanced effective connectivity from the left and right dorsolateral prefrontal cortex to Brodmann area 8, indicating improved brain communication. Traditional Chinese mind-body exercises, particularly Tai Chi, improve academic performance, executive functions, and prefrontal cortex connectivity in children with learning difficulties. Tai Chi demonstrates superior outcomes, supporting its potential as an effective intervention for cognitive and academic development.

Managing cognitive impairment in Parkinson's disease: an update of the literature

INTRODUCTION

Cognitive impairment in Parkinson's disease (PD) substantially affects patient outcomes, function, and quality of life. PD-related cognitive dysfunction is often heterogeneous in clinical presentation and rates of progression. As cognitive changes occur in many people with PD, it is essential to evaluate cognition, provide education, and implement management strategies for cognitive symptoms.

AREAS COVERED

This article describes the symptomatology, epidemiology, risk factors, and pathobiology of cognitive impairment in PD. Additionally, the article provides an overview of evidence-based management and other therapeutic and coping strategies for cognitive impairment and dementia in PD. Comment is offered on challenges and opportunities for trials and emerging therapeutics targeting cognitive symptoms or decline.

EXPERT OPINION

While our understanding of cognitive dysfunction in PD has grown, effective and safe therapeutics are still needed to not only treat cognitive impairment and dementia symptomatically but also slow down or prevent cognitive decline. Further research is needed to elucidate the pathobiology of PD cognitive impairment, develop validated biomarkers reflecting cognitive change, and ultimately, integrate clinical and biological frameworks. Consensus regarding cognitive evaluations, definitions, and criteria of cognitive impairment, evaluating functional abilities in the context of cognitive impairment, and determining optimal outcome measures for clinical trials remain unmet needs.

Effect of group exercise on quality of life for Parkinson disease: systematic review and meta-analysis

PURPOSE

Motor and non-motor symptoms can negatively affect quality of life (QoL) for people with Parkinson Disease (PD). Our purpose was to investigate the effects of group exercise (GE) compared to individual exercise (IE) and usual care (UC) on QoL for people with PD. A systematic review and meta-analysis were performed with randomized controlled trials that studied the effects of GE compared to IE and UC on QoL for people with PD.

MATERIALS AND METHODS

The systematic search was performed in EBSCO, PubMed, and Science Direct databases. Quality of methodology was assessed using the Cochrane GRADE approach. Thirteen studies met all inclusion criteria and were included in the analysis.

RESULTS

No significant difference was found on QoL between GE and IE; however, QoL was significantly improved with GE compared to UC. Results were based on low to moderate quality of evidence.

CONCLUSIONS

Based on low to moderate quality of evidence, GE has a similar effect on QoL when compared to IE and has a small and statistically significant effect when compared to UC, regardless of the patient reported outcome measure used or the total volume of exercise prescribed. GE may be an appropriate option for people with PD to improve their QoL.

The effectiveness of Tai Chi for patients with mild cognitive impairment: a systematic review and meta-analysis

Objective

To explore the effectiveness of Tai Chi on cognitive function in patients with mild cognitive impairment (MCI).

Methods

According to the PRISMA guidelines, randomized controlled trial (RCT) literature on the efficacy of Tai Chi on MCI patients was searched in China National Knowledge Network (CNKI), China Biomedical Literature Database (CBM), Wanfang Data, China Scientific Journal Database (VIP), PubMed, Embase, Duxiu Database, Web of Science and Cochrane Library from their inception to April 2024. The risk of bias in each study was appraised using the Cochrane risk-of-bias tool using Revman 5.4. Random effect model or fixed effect model was used to compare the effects of Tai Chi and control conditions on baseline and post-intervention assessment of cognitive function. Meta-analysis was performed using Stata15.0 software.

Results

Nine studies fulfilled the inclusion criteria. Tai Chi significantly improved Montreal Cognitive Assessment (MoCA, SMD, 1.43, p < 0.00001), Delayed Recall Test (DRT, SMD, 0.90, p < 0.00001), verbal fluency test (VFT, SMD, 0.40, p < 0.00001), and Trail Making Test (TMT, SDM, -0.69, p < 0.00001) in MCI patients. Subgroup analyses showed that 24-forms Tai Chi was more effective than 8-forms Tai Chi in improving MoCA (SMD, 1.89, p < 0.00001) and 10-forms Tai Chi was more effective than 24-forms Tai Chi in improving DRT (SMD, 1.53, p < 0.00001).

Conclusion

Tai Chi improved cognitive function in MCI patients, and Tai Chi types might be the influence factor on Tai Chi improving the global cognitive function and memory function in MCI patients.

Systematic review registration

https://www.crd.york.ac.uk/prospero/.

Knowledge mapping and research trends of accidental falls in patients with Parkinson's disease from 2003 to 2023: a bibliometric analysis

Background

Recent years have witnessed a rapid growth in research on accidental falls in patients with Parkinson's Disease (PD). However, a comprehensive and systematic bibliometric analysis is still lacking. This study aims to systematically analyze the current status and development trends of research related to accidental falls in patients with PD using bibliometric methods.

Methods

We retrieved literature related to accidental falls in patients with PD published between January 1, 2003, and December 31, 2023, from the Web of Science Core Collection (WoSCC) database. Statistical analysis and knowledge mapping of the literature were conducted using VOSviewer, CiteSpace, and Microsoft Excel software.

Results

A total of 3,195 publications related to accidental falls in patients with PD were retrieved. These articles were authored by 13,202 researchers from 3,834 institutions across 87 countries and published in 200 academic journals. Over the past 20 years, the number of published articles and citations has increased annually. The United States and the United Kingdom have the highest number of publications in this field, while Harvard University and Tel Aviv University are the most influential institutions. The Parkinsonism & Related Disorders journal published the highest number of articles, while the Movement Disorders journal had the highest number of citations. The most prolific author is Bloem, Bastiaan R, while the most cited author is Hausdorff, Jeffrey. The main research areas of these publications are Neurosciences, Biomedical, Electrical & Electronic, and Biochemistry & Molecular Biology. Currently, high-frequency keywords related to accidental falls in patients with PD include risk factors, clinical manifestations, and interventions. Prediction and prevention of accidental falls in such patients is a research topic with significant potential and is currently a major focus of research.

Conclusion

This study used bibliometric and knowledge mapping analysis to reveal the current research status and hotspots in the field of accidental falls in patients with PD. It also points out directions for future research. This study can provide theoretical support and practical guidance for scholars to further conduct related research.